 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。+ p( `% V) C( W k" m9 j2 d3 |; u
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Settlement Disclosure
. i! l2 S# y3 I7 ]; vFinal Settlement, d4 G! q' [3 Y3 Y
1 j8 h9 [0 e+ T2 Y( `1 vCAR A:
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Maker/Model - w! W# C3 y& n/ u ~6 W
Serial (VIN) # -0 A" }( W* V D; v' r5 ~( J0 ] E( [
Plate Number:
3 N* R9 O5 k& `Driver Name: (called driver A in this document)
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1 H( w# [0 `1 b3 x: G+ o* n1 y0 f7 gCAR B:
2 c4 j% K) n0 {& OYear -
. [$ B% h' u* x3 s( \+ y/ `Maker/Model –
8 a9 l+ h2 g' M7 B, WSerial (VIN) # -
) _. s- X4 F5 v2 Q& U% lPlate Number:
2 |5 j5 {) x/ C2 e9 W2 F3 ODriver 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.+ n( d/ P2 _. e, Y. n
0 f& s0 J" \, JThe driver B has paid
/ d& Z: w' j3 l9 J" e/ d1. Bumper repair: $% D! c, u" T W$ w$ r; J: w& u& L1 c
2. Other Compensation: $
A: p/ _3 }0 G8 x; j# T# ?1 u
5 F. }# B9 o' |' S1 ?, {) Adriver 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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0 _ f& H, R1 n! T6 ?2 e' C% n) jDriver A:
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- ]$ X7 [7 b; R6 _Signature Date:) y! |2 V+ O0 e& C
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Driver B:
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' a( t H8 _5 w- GSignature Date:
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Witness:
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& P3 E1 W: u/ HSignature Date: |
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