 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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' H% l2 S9 f* ?4 N% bSettlement Disclosure
. L* D, ~/ E' O& |: WFinal Settlement
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. o2 E; Y$ a& E+ @. _CAR A:
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Maker/Model -1 ?8 `9 v! y4 E1 @' p
Serial (VIN) # -
0 Z$ O4 M1 J/ k! u" f% NPlate Number:5 Y1 g5 Y0 @5 U
Driver Name: (called driver A in this document)
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CAR B:; q6 z8 W0 g0 ^, S
Year -; B/ I- `7 Q! w, y8 o
Maker/Model –8 k- N. z% j7 g p4 X9 u& \
Serial (VIN) # -0 S! J# {# y$ i- \9 _ d
Plate Number:
# g, `1 H! ~; X; t j6 {* P$ sDriver Name: (called driver B in this document)5 H* `6 u/ K. v3 z' K, S
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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- o7 H) Q2 U' H% F1 U x, G0 fThe driver B has paid: I- m0 ]* i0 T" ] g# s
1. Bumper repair: $
0 i8 ~+ a6 e9 ]; o; _" J2. 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.& Q1 }- n, b3 ^5 |" U
) b. T9 i% }3 y8 XDriver A:
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Signature Date: Q; ]9 p3 G# c! N8 r
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' J, ]3 c( Y' b: {' _Driver B:
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Signature Date:' k! k- S$ Y; E( ?& u4 S
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" o+ d2 [1 K* Y8 v. Y5 U( D( hWitness:
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Signature Date: |
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