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这里有一份
自己酌情改改就可以了。8 k! R& R$ ~3 n/ M) K+ k
6 e( j8 S' S9 [; p' WSettlement Disclosure0 w) f' {+ V! L K/ V
Final Settlement
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7 L/ K( S! S2 GCAR A:, C# L" a2 F3 M
Year -
# H, ~* {6 K3 ~$ Z$ ^8 `Maker/Model -
/ w% S# J7 d7 S2 h+ Y, a$ _% O1 MSerial (VIN) # -
, U1 N, z0 ?% x$ {4 y8 ?4 K: KPlate Number:' ?3 Q5 [7 P' g
Driver Name: (called driver A in this document)( F, d( G2 p- E6 j8 K2 @1 _! s
0 ^' }1 v& E0 eCAR B:
% j9 B' v, }. ~; \+ G% iYear -) e2 w4 V# X% \% i9 B
Maker/Model –9 ^) [ S( N! D q
Serial (VIN) # -3 r+ s. ? N3 L8 G7 ?* l
Plate Number:
$ X7 L, c) `- n- i6 cDriver Name: (called driver B in this document)( y, b4 Y* f- E/ }/ W2 F
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.0 W6 P) b: o* w/ O1 }9 Y* W
% m: M8 s8 a9 H( o+ [The driver B has paid
9 v/ ~/ s: C5 g5 g3 V+ G1. Bumper repair: $3 ~" ]0 g! B9 c9 b% c
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.# O# i& W U+ [7 }& {2 T
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Driver A:: [! F2 y- f0 s/ f
; L4 e2 c* P: a% SSignature Date:
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1 k! t Q ^: [Driver B:* m+ }. |% w9 W. r9 G% m
8 C3 U% B6 X0 aSignature Date:
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Witness:/ Y( l9 K G, X* P" W+ ^
4 r' @( U, v, o2 CSignature Date: |
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发表于 2008-3-11 09:16
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