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这里有一份
自己酌情改改就可以了。, m S1 W0 x9 m8 |; R. v' x
) k% [# K6 Q JSettlement Disclosure, L! ]) ?, v1 ?2 @
Final Settlement
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CAR A:
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Maker/Model -
4 }( s+ A% B7 r+ u2 hSerial (VIN) # -
, I. e; q4 q! x+ Z8 sPlate Number:
# T( j G2 x, ?Driver Name: (called driver A in this document)
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CAR B:8 R- H3 V) x* u: A4 Z. j
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Maker/Model –
& C v. S4 k `7 F8 sSerial (VIN) # -4 r0 G6 H* {$ W3 r9 X) [$ e- D1 Y
Plate Number:+ s) B1 ^1 ]9 e, v* G, i2 v, t
Driver Name: (called driver B in this document)0 e X% A1 {4 c' m' \
& j1 e( o$ [+ `) x9 R/ R) e" U1 ~In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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) ]: k, f2 P1 g8 W9 j3 R3 x* C5 RThe driver B has paid) F9 B/ i& D; L6 M% e
1. Bumper repair: $6 u8 ^% K# m5 z, L; P
2. Other Compensation: $, k5 @1 \' w$ O+ g$ ?
& f8 |' z/ L: m* `- N- N4 tdriver 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:
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Signature Date:
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# p# w8 y+ E8 J; Q" uDriver B:7 \& Q( `8 l5 g" ^% L9 J1 B- S
8 n( v1 f1 k9 \: {9 ^Signature Date:
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Witness:& r2 K1 [* _2 `: P
; F+ V9 s3 M' W* }Signature Date: |
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