 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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Settlement Disclosure
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CAR A:5 _2 g' G9 E$ g$ o
Year -
: \. \4 m, P- L7 F# c: b( eMaker/Model -5 \; ~6 X% s4 ~/ j: l e
Serial (VIN) # -
' _: [: x0 N _! u! l8 b4 W0 n1 ?Plate Number:, [& K; y7 z: T% L3 y2 g; k' y
Driver Name: (called driver A in this document)9 ]* Y! |/ h o
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Year -
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Serial (VIN) # -( E3 i7 G! j) N$ y
Plate Number:. F6 H, f# {+ B6 O: H
Driver Name: (called driver B in this document). W8 g' w2 w) I, V/ S/ L7 H. G
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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, e" H. v6 {% f$ R& X% }" O6 W% LThe driver B has paid
" K5 J! i, e9 k# p; h/ y. I x1. Bumper repair: $
* O! @9 I$ J. g7 E2. 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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Driver A:" \" D' v T, S
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Driver B:5 E1 h3 y# k% j( }/ D
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Signature Date:
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Witness:! y1 M/ i4 a$ d3 N% S
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Signature Date: |
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