 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
0 |+ h4 I3 J1 `! v; HFinal Settlement
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CAR A:
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Maker/Model -1 X7 y2 C2 t' h" M' [' n+ l
Serial (VIN) # -
5 a5 X9 D. I1 S( K) EPlate Number:* {8 l7 C, o) u: S& G8 V& x
Driver Name: (called driver A in this document)
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+ h o, x7 z, F! ^1 ?CAR B:
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& C8 U3 X- t9 L4 v; @Maker/Model –' c$ J1 P( G4 ?2 B
Serial (VIN) # -
- l1 F/ X9 N, E2 cPlate Number:" K; O/ ^0 t; C, o9 {% \
Driver Name: (called driver B in this document)/ x6 h3 K& N, h" w9 j' x
& c. J1 \ e2 ZIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.# b4 D/ N9 X: r# x* L
& E5 Y5 ]; {& O/ `6 e" j# \# Q2 _8 GThe driver B has paid
+ I, U7 U$ j7 x* ?1. Bumper repair: $
3 P6 v4 t% ~, l$ c+ X; r2. Other Compensation: $$ G. S- b6 F2 H- U# y
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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:' u" j& Z% L" n; k2 h
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. k x! X0 @% s- x n4 F# I, P* j" SDriver B: |. ?2 z' O9 C" L" q' S% t
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Signature Date:
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Witness:
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Signature Date: |
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