 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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& E2 q. P) A4 ?Settlement Disclosure/ [ g6 h" s# O4 n2 ^4 L
Final Settlement+ W: K1 k# v) d( z4 _4 t
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CAR A:1 p0 p" V/ q+ q
Year -
6 h+ v3 ?" K7 B' Z9 Y2 O0 j# }Maker/Model -( ^2 X* p' M9 G5 K1 b$ g
Serial (VIN) # -
2 Q1 n3 S( @. |& L, R V+ H! yPlate Number:; I: q0 a( i5 g' Z. \
Driver Name: (called driver A in this document)# C6 B5 L, L& R# [
0 ?) q: p3 ^; g; @CAR B:9 ^. W" x* m: Z/ q- E4 |- g/ L$ P
Year -
5 d& C+ `% }3 v, b* _Maker/Model –! `0 R% V+ ^1 U! b u6 ~
Serial (VIN) # -
; R( h9 L; w- Y- c% V, N4 kPlate Number:
, \- g9 }5 m" dDriver Name: (called driver B in this document)* x" m( H1 F. d- \. }; B
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.2 t. q6 V" z! ^" N0 f- _9 a$ Q
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The driver B has paid. P. Y& u9 w" P7 t
1. Bumper repair: $
" M+ Z0 w! i) P; I; F# H3 z2. Other Compensation: $' o( g. `' c9 ?+ I$ w- B+ y
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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.
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; V7 B) h( A; E" J) I2 iDriver A:- t& z6 v- f' O5 Z0 H; L& _
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Signature Date:
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. b' E. Q4 n% l4 `. v* qDriver B:2 B6 p3 V+ r; [! F# K3 K
/ z4 ?1 q, C) g3 LSignature Date:' H8 o* y$ i# u
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Witness:4 y1 h% s, K8 |! ^
% G& E: _; t) }/ P' U; _% QSignature Date: |
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