 鲜花( 3)  鸡蛋( 0)
|
这里有一份
自己酌情改改就可以了。1 p2 r/ C8 `/ O3 n! Q
1 P! v9 C( A' j7 a3 x
Settlement Disclosure
( q: o1 M2 m$ O2 [0 X) E/ lFinal Settlement8 N6 [- W, G4 E# H2 P
1 v, ]+ F1 S" t$ A8 m+ nCAR A:* y! a* v: y! ^
Year -
0 s5 E! A+ U' }Maker/Model -7 [5 C. j$ a/ i# V$ j: y5 v
Serial (VIN) # -% w2 B! B: r- d0 P' O$ y
Plate Number:
+ K4 H/ I8 C: l3 O3 W3 i! A5 v' d4 ZDriver Name: (called driver A in this document)
& x8 G$ _/ C6 I7 D! F4 u# f; P+ [+ |# |# |
CAR B:
" E& ?! K7 T$ {* G7 SYear -) E% k s$ {# c" T
Maker/Model –
. L" Y% T; L2 l( b) ~- z DSerial (VIN) # -9 D7 v2 Y2 f; @8 ?3 w, ]$ M
Plate Number:+ f0 V- ]9 o8 @1 m* K; U+ Z% t
Driver Name: (called driver B in this document)
% G$ f# x$ o' ^: x
$ r! G3 u' i% z( mIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
9 @7 O1 H' W1 }) S# I
/ G, ?( I$ V& {9 BThe driver B has paid
; ^5 X7 R# a5 L. c# Q p2 }( J1. Bumper repair: $
* Y R; C4 ~; C R- J& w2. Other Compensation: $4 K% C9 b4 C+ I6 [6 \! H) P
4 I& ?$ ^: u z$ R! Y# q# @$ Jdriver 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.
2 J2 d2 Q1 {4 N- T7 f) L8 p2 n; q) k( z4 Z8 Z: {
Driver A:# z8 \2 |; Q% S
% |* ]% v0 T) _+ L/ O A/ l
Signature Date:
Z3 s' u4 y$ v9 S$ `2 q, A& y4 ?- l8 \, L# K3 U
, i ]' P. T. d) y0 Q
Driver B:" F" b# H3 z" E/ B8 k8 K
; P& L, O! B [' W8 H2 j
Signature Date:/ L+ A4 ?% r B* \- L l% G
0 l$ G* D( M3 U; F* K7 N. [- z2 ~3 l1 |# x) u$ H& [/ T
Witness:4 B/ r/ d: V$ Y" D" S
) n( u3 k; U" j- n
Signature Date: |
|