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这里有一份
自己酌情改改就可以了。7 s6 ]1 S. P+ T' ^
; f$ `% p/ K+ ?4 w& PSettlement Disclosure
8 e% b( I/ H& a1 n- a0 P8 h4 y& d. c# WFinal Settlement# s, `: M. @' G B" ~4 l
) |0 P% ?0 L3 F; O' F4 _CAR A:8 J7 C+ ?* U5 x5 m
Year -, Z9 w, D: B* U5 z. A
Maker/Model -) g1 [# N1 k. h7 n' u0 L3 b
Serial (VIN) # -
, y3 p; v7 `3 n" M* i5 k5 JPlate Number:
: Q4 ]3 ]. a' T$ z8 g: f+ Z) d1 C aDriver Name: (called driver A in this document)
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* j' H+ ?4 J5 UCAR B:
4 i: ]$ {- C F, O, LYear -( m% p4 g& I" y% R8 r! G( Z
Maker/Model –% a C9 U, c. I
Serial (VIN) # -+ }6 K* e( |) r' S$ C1 z
Plate Number:. u7 E1 ]) X* j- V/ i
Driver Name: (called driver B in this document)7 ]- [ w1 D% ~) H4 m
" M. o% J8 Q6 q' i% VIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.4 X2 t" X2 o5 n2 L0 \1 `; q X; S
6 g& D8 Y# i0 e" d, ZThe driver B has paid
: i. N$ l3 ?/ @ J- R$ u y1 P( \1. Bumper repair: $
8 b b% y+ h2 F5 z" k( w: K( ~. c2. Other Compensation: $
$ @8 m' b2 D5 X+ k$ S9 A7 v3 n/ P3 d" e/ o- P2 s) C. h+ g. u7 a
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.* `. ^4 I& j2 U7 \7 ~
1 C# l7 {% }- v# I# v7 XDriver A:" `6 @# L: ?& N
/ `- f, Y) M% \) B2 s* c0 nSignature Date:, z, U5 R. l; u2 ^7 l* {& k; V
+ t1 K/ d* J9 b% t- \# b8 q& h- [+ q! |3 D8 W- T
Driver B:/ v8 F/ b: m# s9 ]7 k
: B% G( l) N) o t( WSignature Date:7 I7 j' W7 r# B0 g) G, |& G
7 I; W# E, T, q5 Q8 V# F
$ c. k, ]. H) E1 dWitness:
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Signature Date: |
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