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这里有一份
自己酌情改改就可以了。$ V# j1 _) F/ k2 T
1 c4 e. k9 e; N' n1 I7 aSettlement Disclosure
( K. o# u5 i% o! WFinal Settlement
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. ?7 p9 d, U* Z8 yCAR A:! T7 c9 g) S% m0 G, ~
Year -
# p1 s7 O4 {' ~( i9 W3 ~ [Maker/Model -' P6 [* N" g/ [# w) e# j$ m! @
Serial (VIN) # -
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Driver Name: (called driver A in this document)
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CAR B:
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1 F' D z& M& C _- m% L( M9 GMaker/Model –( B9 b' s% u! J9 {
Serial (VIN) # -6 o i6 H* M3 t, P5 X2 U% X
Plate Number:
/ J1 r! s8 o( X' y1 F( @: EDriver Name: (called driver B in this document)1 L1 x6 J/ D& t0 n+ g
( c" r* p5 `* y# M; w+ ^1 G" h8 ^In the afternoon of Nov. 7th, 2007, car B hit the back of car A.) b' _& e ?6 d8 a8 o
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The driver B has paid
4 z! M* @. ?8 V8 ]( o0 K1. Bumper repair: $
' C# S8 d9 i" W3 b# g, Q7 I# d2. Other Compensation: $- E& q7 d8 W: a9 S6 H& r1 v
" P& C' `- R" z% {7 Bdriver 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:( e. @! d" y7 a/ K# |
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Signature Date:# f0 o0 r4 o( Y2 {2 j) L
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Driver B:
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Signature Date:
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Witness:
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Signature Date: |
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