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这里有一份
自己酌情改改就可以了。; K/ R. A4 s! `; |5 e; y
, p U2 P/ w/ m% z, ^# ISettlement Disclosure
# o @0 P' @0 k \8 J# }( n( Z6 BFinal Settlement
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$ j J2 M6 L2 r; F! E6 J) I# eCAR A:
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Maker/Model -
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1 G1 @; ^* o6 yPlate Number:# N, h0 F" i6 }, x# ^3 g/ l! y7 Z8 m
Driver Name: (called driver A in this document)1 d6 u# Q# t& @7 [3 c0 O$ e
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CAR B:9 L; M2 k; q8 Q" g$ T% g0 B2 d; Y
Year -% [4 e6 G2 S2 g {% S# o& h# W
Maker/Model –* ~8 }! }) c* J; x
Serial (VIN) # -/ q: ]$ Y' _7 e( u
Plate Number:3 \# E0 Q3 ]4 V! I+ C) V! h/ B
Driver Name: (called driver B in this document)# n( m# p$ U. }# b0 T) ~
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.6 N9 m1 \3 @6 ]( f
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The driver B has paid
! X$ l) v/ J# f1. Bumper repair: $# G l4 w, o' x/ q6 L
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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6 X" }2 I% S2 J# c7 u$ vDriver A:
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Signature Date:
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Driver B:
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Signature Date:
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Witness:7 {5 O; F0 s; F" o
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Signature Date: |
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