 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。* y# P" h+ }4 F/ m9 ?8 O
, d& k& I% g' f3 CSettlement Disclosure
% g0 t% k7 N. Q ZFinal Settlement, V! H2 z ]! q# P; v' @* ^3 b
) R6 L2 B) {( a7 m# s; l3 V! hCAR A:
! S. }: {2 U4 z! \ P; |$ DYear -. q" s: D, k7 ]2 p; {( c8 |
Maker/Model -
3 p& K# h3 @7 |5 YSerial (VIN) # - f: Q6 r: w6 ^$ d) a# a; x
Plate Number:
" ], i7 u5 D; V4 j3 pDriver Name: (called driver A in this document)
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: w# I. g" a, q! z% g# KCAR B:
6 x$ \: \8 Y8 {Year -
9 Q1 N) t; l! S2 G' @Maker/Model –8 w6 x4 j7 n3 }) c3 H
Serial (VIN) # -* w, y! z" G" X# j0 r! `
Plate Number:
+ ?1 s Y/ U8 B7 g1 C8 b( S' @7 SDriver Name: (called driver B in this document)
: B) {# V# i* r' _* _/ y# t+ Q6 J% Y" _) |( g5 u$ E9 k
In the afternoon of Nov. 7th, 2007, car B hit the back of car A.# q. [, E6 Z$ P
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The driver B has paid. B3 D+ G' V9 s- _+ |- o% N
1. Bumper repair: $2 s% R- s" A' p' b
2. Other Compensation: $$ B8 v& p; O. E( R
; B: Y1 v" F0 N% C. N) N" j" C' cdriver 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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/ x0 s% B) {. o5 E0 H! UDriver A:
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7 ]- Y) E& I7 |Signature Date:; W* f" i+ M# K, b1 O, N H2 v
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Driver B:9 y" {, ?$ x, x
; k, d- q8 u8 _% ASignature Date:0 F: B; @" l! [3 E* Y5 C
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Witness: N# K% `' I$ a, ~9 ^! S6 s
. \1 x9 y( `9 u% S, ^/ o$ QSignature Date: |
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