 鲜花( 3)  鸡蛋( 0)
|
这里有一份
自己酌情改改就可以了。8 I; q! ]* U" `0 p$ G% r% g- }2 l
0 X7 D7 V; j' w' t6 J% @
Settlement Disclosure" x- H; S, z3 `! U
Final Settlement$ H7 z3 G8 v2 ~, f# E9 m
M. {, D2 v- a' f. R$ ^# VCAR A:
& _( W. z w$ aYear -3 \% r, E: |" q: r! X( W
Maker/Model -
* Q5 g7 h+ w) ?- k! ^# T* ?6 pSerial (VIN) # -
! w' ]0 z F; O+ k/ X8 ZPlate Number:! w% ^6 i" O# z4 b
Driver Name: (called driver A in this document). j3 m \8 T# a, P7 @
# {& |( W( v$ y' t
CAR B:& ?+ x7 d4 ` w# G
Year -* H6 e3 [1 j5 Z! s
Maker/Model –2 T( e* g7 X- [# X2 k7 k: T3 v5 I
Serial (VIN) # -+ J3 W7 b% I6 u- @" H
Plate Number:( n( u) R2 k" T' `+ @1 i; z
Driver Name: (called driver B in this document)
6 D2 T* m/ o0 {* D% l1 R, g1 X; [ n0 m3 B) A( u; X3 F
In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
/ B* R! W1 Z+ K& ]9 s9 u9 H2 `( R
The driver B has paid3 v) @$ ?; t+ K
1. Bumper repair: $' ^: h& {! @9 T7 P8 d6 }" T+ g6 o0 J( f
2. Other Compensation: $& D- `2 b3 N2 t# m" E |9 r6 ^
# j. l- I8 w+ J9 t; A8 W
driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.9 B/ m4 X5 f' A3 m1 m- s0 {2 K( r8 w
2 @8 M3 _, a$ X: P6 jDriver A:( h9 [+ ~; R) h, l
6 Z! {+ H) ^0 r4 `. o i- k! d9 x4 r$ NSignature Date:
4 k6 M* l. N# N9 s2 h2 [9 V$ ? R0 Y. V8 c8 x
8 |* }8 Z& ~" H; H! ]+ L4 W6 m
Driver B:
/ R& R$ a' j$ |& Q# F6 b# R
5 M& ?4 s1 m0 O! U( f! X4 `2 CSignature Date:
9 H& l3 J9 o& h; z7 L2 g/ \+ x( Y& m# o; `% ]5 }; t( j
7 }; p/ d: s# F9 m0 Z+ XWitness:
" r& e' Z" M4 g4 S) N, `" z, b1 n9 q7 s, _
Signature Date: |
|