 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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# m5 \& V3 x' j% ^$ V- f1 YSettlement Disclosure
3 P( t$ h; t) M4 A$ d% {+ X6 @Final Settlement
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% c0 ~$ C% w# ?( n" JCAR A:% \" a3 O6 i4 X( c
Year -8 s9 I2 `: N& B. Y
Maker/Model -
. T7 u4 ~+ {- v. BSerial (VIN) # -. F) b0 p v# c3 O
Plate Number:9 y8 G; x0 Z' Z5 s8 T
Driver Name: (called driver A in this document)
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( f& x4 F& }1 C9 D6 y+ b5 dCAR B:
4 Y$ \2 ^8 @3 \! ^Year -
$ a! [, `7 X6 P* U( fMaker/Model –! f8 A8 U$ V+ `" d' Z" P" t
Serial (VIN) # -' M* k: V# O! o. ]
Plate Number:
, ]" ?' m1 Y- w4 g$ n( R) f9 NDriver Name: (called driver B in this document)7 N7 Z5 S0 ^( y+ [! i% ]
: ]. z1 V& |- g! i; E/ D- b% c! ZIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.( p& G4 O% q$ }) L2 m7 A
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The driver B has paid( }2 }' }$ S! M2 @! J
1. Bumper repair: $
2 V( n- B5 n, w* U7 o) T2. Other Compensation: $& s8 c: f) h6 T( H6 A
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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.3 F& A3 C" E, u8 c1 b( g
& ^7 D8 x; w, ~( fDriver A:0 H7 f5 B+ |% V3 ]7 M
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Signature Date:' f. ?- ^' A- Z/ w) ?- \) k6 v
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Driver B:
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Signature Date:/ d E7 K3 t/ ?1 m, l
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+ l7 R2 G9 k0 ~' Z4 d0 @Witness:
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; g- f! |8 @! C: k3 j: KSignature Date: |
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