 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! T' e& L+ x% s" G: V" X& J
Final Settlement( ^: Z: q% d0 O+ F/ a& \& _
! Z7 o4 @# M: O- e! t" d1 RCAR A:
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Serial (VIN) # -* Q- g" p. A) i8 r9 x
Plate Number:
/ a6 M$ b& c3 B& pDriver Name: (called driver A in this document)
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CAR B:
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Serial (VIN) # -0 W9 p p& h: S$ Q& w4 t
Plate Number:0 Q# t, v0 k* Z! ?
Driver Name: (called driver B in this document)' y/ a5 R8 k9 }
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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- t: \2 C5 X3 o- _: F8 V4 O' lThe driver B has paid9 [0 q" c# j! L' z2 Z. E. ]! ~1 Y
1. Bumper repair: $
" N' }9 F7 n0 V" v1 |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.4 r" w2 U( f0 [# Y
8 o( y. }; i& J1 l. PDriver A:
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( B7 H! u8 W% }Signature Date:0 J1 y5 J3 k( X! |. D2 i* D4 X6 ?
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Driver B:; B8 F2 N" f+ A; Z5 A
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$ n4 D ]; f- o" }6 H3 fWitness:3 G* k: S0 A7 B
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Signature Date: |
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