 鲜花( 3)  鸡蛋( 0)
|
这里有一份
自己酌情改改就可以了。# R3 K( e$ c' ], R. N
, q, T; f* x, v9 B. @ o1 x& JSettlement Disclosure
- Z* m% S5 ?" ^$ s* w- u- Y% ~3 cFinal Settlement
; A; i2 Y: w8 e; `- k- D, `# v6 }3 Y
CAR A:" M1 o! v$ o' h G
Year -5 m2 s B3 n, ~1 b+ t2 Y! Y
Maker/Model -9 }* \# h7 s; m( b/ l
Serial (VIN) # -0 e. f5 o5 X( B9 B7 [
Plate Number:
0 i" U/ B. q; UDriver Name: (called driver A in this document)
8 B- c/ T: `: M* a5 U
- l& l7 F) H3 G2 q, a9 i! tCAR B:
& m2 Q/ q, X5 [$ I$ UYear -+ n, k0 m; z% Y l9 d! M
Maker/Model –- Y1 }; a: [* M! b
Serial (VIN) # -3 p2 V# e; X! q" v3 q6 Q
Plate Number:
[/ \; t2 j' C F aDriver Name: (called driver B in this document)
0 N+ b w7 f# t; z8 x! E4 m8 m1 y# Q/ @% R
In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
; w6 Z i$ {3 P4 u; \) C2 t, c
' m0 g: D; @( ?0 Y" l" tThe driver B has paid
/ r% g6 p r" r1. Bumper repair: $/ v7 e1 {, ?6 u ?
2. Other Compensation: $& y" S1 Q( t' d1 k3 v
* {8 S) C. Q* D* f
driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.) K5 G4 {; w7 ]4 _9 U/ K
) g- d; h* P. `' j* v! k
Driver A: L3 L5 s3 x8 ?2 g
* D8 ~; c4 c' `* d3 kSignature Date:) I C+ R2 Q: z$ h
+ N" G B0 K5 ~! ?: Z6 p
) |* }! }" `% E1 GDriver B:
% Q) m. ]4 @( H5 q
! W: N& H+ r/ K2 oSignature Date:$ [3 g1 k% q$ q. G+ z1 Y2 j# E; F5 e
8 O" s8 S1 R& a5 j* w2 u& p( H" m
2 E5 ?2 Y( d: M: D3 f7 R/ }
Witness:* F1 J6 y+ d/ X+ |8 P9 a u7 Z& h7 n
_# p+ P- U' W0 {6 KSignature Date: |
|