 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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2 z- X& |$ C3 j) }1 |Settlement Disclosure
% r: {5 Z6 W5 Q2 U0 \Final Settlement
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* S# }0 Q6 _# l: i0 T' cCAR A:2 T+ t- v N% }" X
Year -- G$ |1 i+ o- t* b
Maker/Model -8 Q2 b5 h$ D$ A( j
Serial (VIN) # -. n7 j. I% g/ F( H) [
Plate Number:# u Y7 `" z# {2 \* J$ h
Driver Name: (called driver A in this document)
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+ l4 I8 M- v( p) fCAR B:: F, ?6 t: V, A" W2 U9 x
Year -' R* Z4 }1 l8 n* u; ~- W- Z V
Maker/Model –4 w) r& V: g- i# p* k% A8 K8 ~
Serial (VIN) # -+ F5 b4 [& D' h8 \( z5 |
Plate Number:
' n9 D$ r5 [7 K5 w! mDriver 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.8 F# s1 F+ h+ j
9 n% H( M; ?8 r/ [$ }2 x( RThe driver B has paid' b5 _$ k* ~+ r6 H4 w' ]
1. Bumper repair: $' _4 j% u9 \1 L( C
2. Other Compensation: $
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8 m( K5 m- D. [0 _6 j3 ldriver 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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Driver A:2 _2 N( |3 M( Z! [$ i
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Signature Date:9 ?0 b4 i9 W6 }5 Z" X7 u
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Driver B:$ G6 P' Q, ~- s6 [& h
1 ?/ z. H* F" v0 D' X: W( OSignature Date:7 C! ^$ d1 X. L7 Q% G' z4 j" w$ @, H
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" x& H+ F1 {. LWitness:
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Signature Date: |
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