 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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2 t a- V" d. a! C* I$ @. c7 m9 ?Settlement Disclosure
: c4 I3 I" X& R2 n. B# fFinal Settlement
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& }* T" x! ^5 n, vCAR A:: H! k( k+ M O3 l9 T1 e
Year -6 A$ j9 E5 Z% b9 ]! r! U2 P
Maker/Model -+ I8 D; K/ _) m6 i* m+ s) X. [
Serial (VIN) # -
$ b1 y) H) f4 KPlate Number:" [0 {& X) s9 }5 h0 G# W' E# ?2 w
Driver Name: (called driver A in this document)5 |5 Z( j! v' K3 g7 n
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CAR B:
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" h' ` J! I! a, u2 U2 cMaker/Model –
& c9 j2 {8 c6 e; u9 TSerial (VIN) # -
* Y$ v3 @. `0 [% l3 D& }" J, TPlate Number:$ B" G) T/ F8 ~
Driver Name: (called driver B in this document)& k }: [, h0 P. G/ h7 {3 W
- E- U# n& q% k3 UIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid8 F1 {! \4 q$ ~9 V0 q% K
1. Bumper repair: $: N( }2 ?) e( X% S+ q2 ?# I
2. Other Compensation: $
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% b- a6 B" I! ]/ k3 ]- u, r N! Tdriver 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.7 @* u& N( S) P) P# G0 r* I" ?# T
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Driver A:2 y9 X/ ]6 n, G2 n. L" f
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Signature Date:1 D! O6 E A7 p
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Driver B:2 K- M; S6 g$ t6 W* |1 D3 I" _1 J
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Signature Date:
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: M4 ^" c. F0 A+ o4 M$ H8 }+ t& GWitness:5 _! J+ r% a8 s$ F- K0 C8 M
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Signature Date: |
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