 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。& u- q2 f; X4 Y* x* t4 E
* j q8 U! S7 ?2 F0 a% S& SSettlement Disclosure
& W. O# ^. ? y+ a+ A8 GFinal Settlement5 v- y6 G5 }( a
& K" ?+ A) R2 U1 k6 c7 _CAR A:
$ t6 z& y. Y' ^# f+ V+ t7 s9 h, F1 wYear -1 j9 T, t. k/ D6 k C( ]9 _; Q! B' v
Maker/Model -" g0 ?+ X `0 M' \$ r
Serial (VIN) # -
3 _+ M: v6 c1 xPlate Number:! Q0 l' e! T9 M" t& E$ l2 c
Driver Name: (called driver A in this document)
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% a3 f" m6 @; o; m; XCAR B:; j/ }, U( e2 M i0 b/ `6 |
Year -
1 Q$ g8 z5 H7 k- P! O" E+ w: HMaker/Model –$ w4 Y+ P* l' b! T ^- o
Serial (VIN) # -
! \ p# x5 O. l0 v" J" OPlate Number:
7 v" O8 l1 E- W/ ?: CDriver Name: (called driver B in this document). ]- ?! }" H) p, ?" E
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.6 p1 m$ v, f/ p/ S# ~8 a! Z
9 u5 E. U7 ]! iThe driver B has paid+ V# `' U1 |: a
1. Bumper repair: $* ^6 S3 }4 d( @: v+ E9 I" n$ q
2. Other Compensation: $. q3 s4 F- B* C' @# k
# D2 V4 @& L- l2 n9 Ldriver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.' A" F! v; ?3 R* G7 M* `9 n, w
( c9 G7 _& R( Z! E: v4 c& kDriver A:
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# b( M x. ^/ uSignature Date:; ^( y5 j! Y" p2 e6 h
/ z3 z* X/ [. a% m4 _7 Y) M: f
f; d8 Y! ] B( SDriver B:" X4 W( L( V) q2 {7 i7 k
0 {" G5 e# ?7 vSignature Date:
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- J2 c! g. K) z# p# U& U+ b% m$ t/ T" H" P
Witness:* ^6 Q% e; B5 D& X
$ x4 S; i% x) b5 H, C
Signature Date: |
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