 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
$ D8 Z, S3 I# \# |( YFinal Settlement1 h5 w* d! {/ `/ h
- ^1 H1 i3 r8 nCAR A:0 Y; w! S6 b5 i( F3 \6 K6 h
Year -
! L7 ~ b+ O7 I* K' P* e" L1 K% aMaker/Model -
9 c5 D* X ?, C5 v$ e1 \( H2 oSerial (VIN) # -
2 b4 i; X7 D+ UPlate Number:
) p7 U5 Z5 ~" J9 ]Driver Name: (called driver A in this document)% S. x; ?! |+ j, Y6 @$ k
: {" }1 X6 Z- t7 _" n- RCAR B:/ d1 D" h) w- r2 i" c! B
Year -& h' M2 T. R: Z3 L! H a) h
Maker/Model –
1 o* C# u2 p) r9 pSerial (VIN) # -2 F! D8 q" Q g. V
Plate Number:
) T; M# r c- T/ `+ y0 uDriver Name: (called driver B in this document): |7 r5 u( A6 H- J6 F3 K# U
0 f; Y+ |' o" e; cIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.3 {5 U* ~+ V; u- L! ^2 \
% M) Q' t! A# GThe driver B has paid
# h3 B1 E3 y" A& v9 n6 [, b# y6 k1. Bumper repair: $
6 c8 \% m* j6 x+ ~$ O2. Other Compensation: $
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" E2 V/ K5 n' l: Y! u% kdriver 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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Driver A:4 c: r F0 k5 v+ ]' y% D
! a; F5 o$ W2 J& C, b. k! t: q5 ZSignature Date:
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+ t& y, H0 m7 o6 GDriver B:4 y. x3 o" z7 n! e* W2 z: g1 K
3 l. V3 r9 T- O6 v* I zSignature Date:
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Witness:9 f4 i5 g5 ~5 F! G2 }
9 r$ L w6 b# l! Z, {. z' gSignature Date: |
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