 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。& K1 k6 G! Q- ~9 U* @
) @0 p- l7 ~/ q6 M5 F$ X" b% ASettlement Disclosure
$ h8 U! W* \) B" i2 C, @4 ~, GFinal Settlement/ ]2 f* M7 K5 Y& h* q9 ^8 L
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CAR A:
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Maker/Model -
7 m6 W: L* F2 `1 R0 y* j GSerial (VIN) # -
* C+ f1 Y5 I/ `6 LPlate Number:% d1 v, g- |8 u5 H) ?0 a2 {
Driver Name: (called driver A in this document)
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/ m, d7 O, y) P) U; y, s3 t6 {& O/ |CAR B:" {$ p4 t, v# c; X+ J! `
Year -
' N& H5 U( u3 ]. hMaker/Model –
# ?6 ]4 w, p; C! C: ?Serial (VIN) # -7 {1 `7 s4 [' e# M* \) x% K8 p) f
Plate Number:7 P2 V( j6 f5 f3 p
Driver Name: (called driver B in this document)
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.* K. `6 @) _' x3 e1 q. ^
9 [: m$ E; Z" G" g9 ]# w; ]( y' LThe driver B has paid
, W/ M1 F* P2 M$ B1. Bumper repair: $
4 w! W& B) V& W* ~2. Other Compensation: $$ a: ]5 D6 \0 j
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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.7 y# c9 _3 i% z
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Driver A:6 X) Y/ F, h d x" u
3 L3 l$ q) f0 l" y# `Signature Date:& i. C% c, A( Q8 [, S% j
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9 ~! j# a3 x0 R) BDriver B:
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& i0 U$ N6 E* S5 _Signature Date:
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' N5 f; u- ?& F$ {4 u, a' }- YWitness:
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Signature Date: |
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