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这里有一份
自己酌情改改就可以了。: `* B. _5 C$ Z& A( \
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Settlement Disclosure
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CAR A:# D3 M& ~% t o1 H' e
Year -
$ |" E' H* O% C* r9 ?! M2 Y1 rMaker/Model -
' h, c6 p# i4 C5 e+ a2 l0 `Serial (VIN) # -* A( T4 p2 C: g' Y( D1 X
Plate Number:
6 h; B) m8 A3 ODriver Name: (called driver A in this document)+ a( d4 P4 s1 c3 f7 N/ U) {. v
. E* S/ b# X( e7 A' e' QCAR B:
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Maker/Model –
3 H2 D# |. h5 l0 c P N6 Y- R4 ~Serial (VIN) # -
, ]2 B1 E4 x9 x9 W6 d5 ^! h* RPlate Number:
2 Y: G R3 ~/ x) \& QDriver Name: (called driver B in this document)9 _5 x7 s2 G# P" L
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.+ P" G& ?0 z$ U
, ?- Y1 Q% S9 H+ z# x9 U6 j2 QThe driver B has paid+ _+ q1 [, z0 y: y+ J9 Q3 F
1. Bumper repair: $ k" H1 G A/ J: y
2. 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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. _2 h( \" a. m, bDriver A:
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6 g4 |+ B1 s/ g0 A; A0 kSignature Date:6 B/ W- E- _; N2 T0 I; \" S; [7 M: E2 h' ~
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4 F7 A" k2 e! G- h( D MDriver B:6 y% }% M. Y( P! t u$ \* f; r
, _2 `8 Y% J: R/ T# uSignature Date:
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Witness:" |% j; `4 c. L: A; T) d+ }
# G+ K2 o1 [9 @& c2 }Signature Date: |
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