 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
4 V7 K; ^7 F4 L" Q# H0 Y% A/ ZFinal Settlement
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/ m5 Y* p* Y2 rCAR A:
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% M9 t0 t2 b* m5 cMaker/Model -
: k5 L6 k, E) ^5 r. D" w6 f3 }Serial (VIN) # -% M; x$ P- S1 B& D
Plate Number:
2 | M" w$ r7 P( w4 j7 U) fDriver Name: (called driver A in this document)
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8 O7 \! }% O* J: Y _( }CAR B:; Y7 Q1 W. ]- p5 o2 j4 u
Year -8 ^/ c0 x5 w' |& t8 W1 S
Maker/Model –
5 V6 k& C. @8 U2 N& O; eSerial (VIN) # -
% b3 N2 D2 S, \: H( vPlate Number:) Y% }! [, z5 Z+ E% H
Driver Name: (called driver B in this document)1 h8 ^0 w+ C& ]: @0 O. \
6 j+ y. G6 A2 K# N7 VIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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6 p8 Z8 x4 C) J+ \The driver B has paid* @' ^) Y8 e8 [* `* t
1. Bumper repair: $
6 T* q) a! y9 k& i2. Other Compensation: $
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" u3 w/ Z# t# Q% Zdriver 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.
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Driver A:
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1 t X* R4 Z7 W% ~Signature Date:
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Driver B:' Q# ]- j# k: O) \7 K9 F2 ?3 B
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8 {- I1 Z9 R5 V# \: e6 o4 h) gWitness:0 e8 h+ k4 w" Q9 h6 l3 S
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Signature Date: |
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