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  鲜花(3 )   鸡蛋(0 ) | 
这里有一份
| 自己酌情改改就可以了。 4 s7 T" V5 {; ]: @& K! A5 U
 1 F/ A3 A& c2 nSettlement Disclosure+ H* P" R+ ~1 ]
 Final Settlement5 Q1 }, g  B) }. w) K5 [  J
 
 8 W' V6 [* f6 A6 W) p$ D$ ECAR A:( O) I5 i: x( U8 z( {- K) q
 Year -4 M* N9 U. O/ u3 s/ L+ B
 Maker/Model -
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 Plate Number:/ q5 B+ e  T# c5 ]2 ^
 Driver Name: (called driver A in this document)' H. b, s. u( C0 }, F# B
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 CAR B:
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 Serial (VIN) # -$ w0 F1 A8 _: V
 Plate Number:
 $ ]) K" Y( r; ^& }# u, `0 M4 a8 VDriver Name: (called driver B in this document)9 I, b& e2 b6 s, D  K. T. o
 
 , o$ M/ c- x, g6 n0 rIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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 The driver B has paid
 # \9 c: L" F2 b1. Bumper repair: $, e, H1 z9 N+ J1 S& \
 2. Other Compensation: $
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 6 n/ q* h2 K" r6 \0 R( y  ~8 F/ \, Ndriver 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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 n; u$ x3 q- v# C) }0 |' RDriver A:
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 # M0 i+ g+ ]8 r  {! i6 q0 u$ k7 x3 ISignature Date:. E" n) U% k- [+ ^, `9 h0 D$ X; ^
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 Driver B:7 S1 b, w$ _/ E5 ?2 ~# `
 
 7 O( w, |% ?" z0 o5 D( U* w7 M  rSignature Date:
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 ' T1 k5 c8 d9 D6 c5 J* }Witness:. H0 ^9 t0 S1 X! D+ u
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 Signature Date:
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