 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。$ q: w, n' J# v0 J- K+ Y/ a
4 v5 f4 N+ Y* F* C T: |Settlement Disclosure
8 ^3 Q& _ i5 O' hFinal Settlement- H+ a6 N: ?8 U3 Z" I9 ]" J
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CAR A:! A9 u1 u( j7 z4 Y
Year -
2 w* T% z! d( o) i6 s1 N9 S- \9 J0 uMaker/Model -) g5 e: C+ r5 p6 l
Serial (VIN) # -
) v/ d, Y; Z* vPlate Number:& B! |% w3 v3 V5 m2 \# J
Driver Name: (called driver A in this document); T! s' q y! J% T' l/ P
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CAR B:
) }& e" G2 b) H+ N. F+ [' y pYear -
' o/ v5 f7 q0 c! t! U# |2 x; sMaker/Model –
- o( ^4 b# o$ J( ySerial (VIN) # -
: e. n, b. V6 b/ BPlate Number:
1 J" W6 m0 C+ @7 F! nDriver 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./ a5 S% w! X9 L0 n4 H- ?3 I9 z" h
& i0 w" b: M6 sThe driver B has paid
; ~% ~9 a3 h; g8 G6 `4 H9 o& R& d1. Bumper repair: $0 g1 @, n% F9 t% i9 }9 t
2. Other Compensation: $+ t& {% Q) [; v5 ~, G
9 P8 e% i1 A- m& A1 ^driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.
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$ _# @% @ m pDriver A:' y7 m; X/ ?8 h9 _
1 m- {8 K1 ?0 j5 B+ z2 PSignature Date: e& Q( w9 u0 B( y# z
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Driver B:
A2 }: Z: k9 \+ Q) R. P2 r& |1 k, ^) r9 d7 R. l
Signature Date:
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3 _8 B( X2 C' m6 U8 V0 _Witness:4 r* _# J! w) g2 V" ?: y# E
' r& Z& x2 J1 q; @* B) r F& DSignature Date: |
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