 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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Settlement Disclosure
6 O# c, }9 I/ h, L. @Final Settlement, z% [1 {% [+ Z1 d# }" @
" P) z7 ^, ]7 o7 |1 eCAR A:
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: P7 n" v& L: [' W7 ^& a/ UMaker/Model -
- m: T; @0 I3 \! |- @ M8 XSerial (VIN) # -
/ _: k F9 X* K: C1 ^5 d2 ]Plate Number:
2 w7 F; W# Z3 g! A" G* @4 ~: gDriver Name: (called driver A in this document)& H5 ` |7 w. `
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CAR B:3 X: I2 ~. C! o/ `1 J
Year -7 A2 ]' A+ _, f D2 ~1 u7 C
Maker/Model –
3 J& c5 e9 S: ?9 a0 k/ W+ E9 e z- T) rSerial (VIN) # -
" v5 p) O4 C% S# Y& `8 kPlate Number:, J; z! P0 } | Y
Driver Name: (called driver B in this document)
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% {6 D- G$ `6 tIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.) {9 D5 v* F9 T' O+ C2 s* ^# w
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The driver B has paid( G9 j/ t" w+ y9 K& h8 t
1. Bumper repair: $& m% U# I+ q- U
2. Other Compensation: $. {, p# a5 ?' w& k0 B3 o/ e
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driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.
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5 q1 ?7 S7 O) A. mDriver A:
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Signature Date:9 N2 V$ o4 W+ w4 b4 z
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7 `( Y) `8 K9 b) I3 DDriver B:
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2 e7 S8 ?1 p: S* {6 }$ b* FSignature Date:5 Z* Q& x! {' C2 R
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Witness:
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Signature Date: |
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