 鲜花( 3)  鸡蛋( 0)
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这里有一份
自己酌情改改就可以了。
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Settlement Disclosure
2 I9 u- q8 `! v1 k T' pFinal Settlement
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Year -
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Serial (VIN) # -
( i h2 c6 v% xPlate Number:
' @! Q! j: q3 p4 LDriver Name: (called driver A in this document)
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9 x) {* J# P: BCAR B:
5 p5 n5 \" w/ b: q8 BYear -
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Serial (VIN) # -; S4 r9 n% ~5 C9 `' k' J' N
Plate Number:; W$ S0 A( U; n0 d9 z% D
Driver Name: (called driver B in this document)
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid# i, c% b" M9 K1 r! B
1. Bumper repair: $
2 ]9 w5 n3 V; ?# L7 G2. Other Compensation: $
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driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.+ y y' x% W! Y
1 _) v/ h. d4 U7 ADriver A:7 b% |) x& [7 l, ~
9 x+ |! v7 ~3 K. @Signature Date:
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& w8 l/ W0 L+ c& f% Z0 eDriver B:3 z& s5 f% q# `/ E4 V* ]0 w
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Witness:
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& V9 O+ h1 ?: b2 |7 n2 V7 w7 FSignature Date: |
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