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  鲜花(3 )   鸡蛋(0 ) | 
这里有一份
| 自己酌情改改就可以了。 ) I# P, k* E7 Z1 n; P; w- S
 1 x; l+ P8 r9 |! k2 fSettlement Disclosure. w6 G# f; C& R  U
 Final Settlement' }/ |  C+ @! h8 |8 X
 
 * t8 B% c2 ]& y& D/ nCAR A:7 L7 H) G8 U6 M, G" ~
 Year -
 5 S' B" w: H3 [: C9 E7 ?Maker/Model -6 ?6 [* S3 \/ v5 v0 j
 Serial (VIN) # -
 0 R# H  }9 B2 iPlate Number:* Y. x6 M5 ~3 }* o! |3 \, V) u& ]% N
 Driver Name: (called driver A in this document)4 w' [( s' V6 m( N' ]7 N% J
 
 3 x, l% j# F0 J( d9 J4 ICAR B:
 9 z9 @: k/ H* UYear -- V3 I% P. A* O- E
 Maker/Model –
 / w9 f/ `) x6 ]( ]& ESerial (VIN) # -0 ~, _. h6 P: i! ?( s0 m
 Plate Number:
 ( s! A4 H* I  H! m8 L* n& X3 }: {4 ]Driver Name: (called driver B in this document)6 D( _5 y/ K; I  d
 
 $ s+ F" F; h. R; A# f, R) gIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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 The driver B has paid7 }6 b" v$ V4 ?/ A; R' i! l
 1. Bumper repair: $! Q8 j( X9 B* ~+ I2 K5 ]
 2. Other Compensation: $# g$ i* \2 r# V, ]+ f
 
 5 J8 a% Q2 R" H" Y1 A" F, a" sdriver 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:3 y! m" V. C! f' a' P
 
 ( ]  j# u' ]* `7 t. h% rSignature Date:2 U$ x" I1 c2 x) e/ _0 S7 k" L
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 " q& F9 R& t( W' E3 O% ^Driver B:7 \+ L* L, A. z6 n
 1 V  C5 ~0 t$ y7 g  @* J
 Signature Date:
 $ w: B& S6 ^. ^- w' P$ @9 I5 ]$ a( b* O! Y
 9 h+ `0 C4 l/ X- S, d8 M  ~4 x
 Witness:
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 9 q  a. N" F1 i: K! a9 R! dSignature Date:
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