 鲜花( 3)  鸡蛋( 0)
|
这里有一份
自己酌情改改就可以了。$ z2 G! {# s2 F; q( w
- W/ }, h) A$ ^ ^. w2 V6 u2 K) ESettlement Disclosure
" q5 c+ {+ ^& d0 C: I: MFinal Settlement
# V0 i( L' _8 C7 r8 `
8 A) b' v0 M# h P# ~CAR A:5 m' K# X2 J. |% Q0 p7 o
Year -
3 e: V# e; Q' P0 K+ g- bMaker/Model -) p& `' `2 m$ g" c$ k0 C
Serial (VIN) # -) M4 K( M# @ L* h: x( K* {" q
Plate Number:
% p* Q% K/ D6 B5 a8 bDriver Name: (called driver A in this document)
; J8 C( S8 e. J- g
" r/ l# e. G# d' U& }$ E1 [' Y' jCAR B:
8 m' g) Z2 q5 E/ C' F3 ]' yYear -
" N( r5 K$ k' |, u$ rMaker/Model –0 `/ V( p( }. {
Serial (VIN) # -1 x `( E8 P/ d9 k
Plate Number:
, r% R s* P1 v. z( m+ cDriver Name: (called driver B in this document)
( h/ O0 D6 g4 Z w. Y/ ~! ]! Y% G. X8 i ?, I- q w
In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
$ Z, m& P/ x& I
, {6 Q( T* `0 N$ L3 I% JThe driver B has paid
% I; o1 @; Y# u2 |/ |5 ]1. Bumper repair: $/ i* g; |$ T8 Y5 E, w1 L
2. Other Compensation: $0 u2 t; ]" _+ s# ~$ p* ~. V) M
+ A2 e1 X* |- f; z/ p' l# m# c
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.$ I. H4 F$ e1 J, G2 e9 j, g
9 A0 }1 @4 Q0 \: G
Driver A:
: F9 l, |6 O' z1 \. O4 M$ x6 P2 i9 B2 ?8 m1 _
Signature Date:
, A: `. Z. g( T) i# k, ]3 l7 ~; l& @- ~' q) z4 e
9 ~4 J- x' z( C" {2 l/ yDriver B:2 {* {- b, J3 |2 K. U- A
4 X5 k0 w4 Q/ x' `Signature Date:
; ?3 ^' B0 p0 C+ R9 h$ k+ V8 j; \# U+ o
* P; `; b5 V5 T( H1 q( F
Witness:
8 H4 B |" m% f' z8 N2 E4 m* K- k Y
Signature Date: |
|