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这里有一份
自己酌情改改就可以了。
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Settlement Disclosure" {% ^: S7 j5 y) I8 r# P2 T" a0 s
Final Settlement
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CAR A:
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7 j' ^. c# i- f! A5 d# K' O0 m' gMaker/Model -1 o1 u( Q; g# Q
Serial (VIN) # -3 O% B( h0 ~& R; C: g8 ?
Plate Number:/ {$ y$ w R% J" d$ ], ]% H& r6 A' t+ I3 G2 a
Driver Name: (called driver A in this document)
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Year -
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Driver Name: (called driver B in this document)- v7 |3 f- }: R4 H7 b" H
7 N) R2 k) e) M$ j oIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.. H6 a! T# Z! t1 m
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The driver B has paid9 w- b4 r9 ^# b0 O
1. Bumper repair: $5 L7 ?; ~( e. ^4 u& u+ _" F
2. Other Compensation: $# ^( R* q/ X1 O- f3 k
; H& K4 R1 y% ^: P2 rdriver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.
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5 B# G% G2 O+ ~1 C& R( @' @Driver A:6 [$ e) g& m( H; V; C; @
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Driver B:! e" [" C' h9 i
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) Z' u( A* y- d$ `Witness:
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& q1 e0 D3 Q) d- J6 E" J: k8 b3 h. ^Signature Date: |
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