 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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, Z. s4 n+ H! p$ cSettlement Disclosure
* a( n. l5 W3 \4 kFinal Settlement8 P t% J6 p2 M! H2 Y; J% @
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CAR A:" Z* ~" ], f! V# @
Year -
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" o6 A! N! r, G: s/ t! `- B; c/ FSerial (VIN) # -# Z: P, e3 l' P6 W
Plate Number:
, j7 L& V- b- q' y& Z8 nDriver Name: (called driver A in this document)
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- V+ z: W9 m! E, qCAR B:
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Maker/Model –
( [) Q4 H) P4 ?. @8 x8 \6 w; ZSerial (VIN) # -
3 f7 n$ {9 ~* o9 Z% b6 bPlate Number:
d8 n/ I3 y5 F! K* r+ U: ZDriver Name: (called driver B in this document); T7 ]- U) i' w8 r3 i3 A
7 C% F( J, f9 R2 h; A4 I! bIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.$ U0 g; \$ x }3 J+ ~: D
+ ?4 Q1 U* ^+ ]$ `3 m2 gThe driver B has paid9 J$ s+ d; `: n# ~
1. Bumper repair: $
9 K; }( V0 `* h+ [4 U* _2. Other Compensation: $
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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.. d' o9 P/ b& E2 k3 H) i; Y; [
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Driver A:6 f3 v: E$ E3 M: l+ W `
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Signature Date:& Y! S0 \' K8 T/ R& z. x
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?3 \+ q# V( R1 NDriver B:
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. z* @* T- z; Y* ?Signature Date:
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Witness:
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1 N3 |' E5 l9 l% {9 D+ e! g8 iSignature Date: |
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