 鲜花( 3)  鸡蛋( 0)
|
这里有一份
自己酌情改改就可以了。
/ p3 v! x# _* [' H6 }# w' j" d* d+ ^, M
Settlement Disclosure
+ r9 L/ T2 z7 ?Final Settlement; A y6 q! [$ |7 S; ?4 g, u
l9 O7 p2 ~, ]- ]- l6 P
CAR A:, z9 w- P2 z. B4 n2 {2 W/ i& n2 f
Year -* `( [1 K- W6 c7 w6 `3 D
Maker/Model -% ~$ F1 C2 {/ g/ r& n6 v6 L
Serial (VIN) # -
$ Y: i' p5 |. f' F8 l! F2 j) HPlate Number:
/ i- ~& l2 p7 Q, b2 }8 ODriver Name: (called driver A in this document)
n4 t: Y- G" A0 n& t! {: k5 s4 e9 N
CAR B:; b$ j0 G& F1 c: }: _' l/ U
Year -. A1 g: U( J9 L& i D7 `
Maker/Model –
3 s# c5 _1 {4 f3 q# \( KSerial (VIN) # -
9 ~. S6 P( \; n5 V+ Q5 u3 }Plate Number:
% I, g2 Y6 J* [, E7 [9 F* _Driver Name: (called driver B in this document)* T+ _9 n6 w- r" q5 J
0 p+ f# @/ w) R2 w5 V, N$ V" M. B( g. O
In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
9 x$ m* x( X0 r* \3 ~% T! M- r# |! E t- `
The driver B has paid: P$ u. g* e; q" H& u
1. Bumper repair: $! U* U; I& @0 S
2. Other Compensation: $3 q [# b, z8 K! B8 i0 U
0 Q, H2 c, d5 x; H
driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.
5 R; O* ?7 q* F6 |0 k) m% b" J$ c" r1 t% L4 v5 _. s! M' n, u
Driver A:
1 X# l6 G5 b, M/ y+ G3 V4 L O7 W- `, h/ y$ f
Signature Date:
! _& M7 H* W( P6 L& ^! w# S7 b' s) w5 D
% x$ L6 A0 j% Q' c1 T
Driver B:
! ~7 j5 Z) h9 R# {$ M% [0 a8 Z; }6 a& [4 @$ L* P0 f
Signature Date:- @% D' h1 ?7 ~+ y* {9 f" L4 e& m
" A4 @/ @- @* W2 R" g7 C* s4 I8 b1 j0 D$ u7 s* c/ E
Witness:2 r! b2 r0 C2 f# ^9 U8 p: R
# h6 \0 E f) `* Q# {! T
Signature Date: |
|