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这里有一份
自己酌情改改就可以了。: Y# c( s6 N! ]& ^( u' I3 W% V
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Settlement Disclosure
& ^# M, q4 o# u8 d: y* p/ v5 ]Final Settlement: G7 Q' Z4 D2 v: i$ }
5 B/ b7 ]: o. e& o T: @5 @CAR A:/ D- I y9 s- Y* l
Year -* I' D) _# R% ^7 N
Maker/Model -
# O9 F$ \) \ D3 T7 a. V( h% w! QSerial (VIN) # -
( e" J$ ~. W) J, kPlate Number:/ V- Z8 q& c: g* m0 a8 z1 C
Driver Name: (called driver A in this document)
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" Y% r- `* s7 M1 GCAR B:( g: A7 V8 y7 V( u
Year -
; E% G& Q; k3 i1 |% xMaker/Model –% \# `( O! t7 {
Serial (VIN) # -
! K6 b; b3 q/ cPlate Number:
: y; _* t& Q8 A+ {Driver 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. ^. C# s* U' C2 F6 C' s/ V4 i
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The driver B has paid% B/ y8 k6 W p! G8 H. D
1. Bumper repair: $
, y$ \4 r6 F, b8 i% W* {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.
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7 p0 ?3 V9 l! P' h( {5 r; uDriver A:4 u! w9 K+ V" w
" x9 x' ]; p: b3 dSignature Date:
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* p9 u$ K* u' `5 F. PDriver B:
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Signature Date:. j c# g" a5 M( Y6 V2 U+ s8 D$ w' ?, L
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, k/ \ M7 f" @# d% o8 b9 IWitness:
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9 H+ O; ~7 h% P- ?6 cSignature Date: |
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