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这里有一份
自己酌情改改就可以了。3 H+ P, h% J" [
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Settlement Disclosure
, H( w8 [! Z: R( _4 ]0 P) TFinal Settlement3 L1 K" ^( t9 F2 s6 L
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CAR A:
8 B2 B' X, r* [& b- `Year -
/ ?( b. t0 g MMaker/Model -
# Z* `# }8 t8 z" ]0 U! E/ L9 QSerial (VIN) # -
4 \! ]1 I5 Y2 c. N- n2 kPlate Number:
U5 Y. \( U# X2 vDriver Name: (called driver A in this document); ]6 m. B) ]- K: r7 ?, a ~+ @
@" }: b/ k/ C; B" K) H! X7 m2 RCAR B:
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Maker/Model –
8 I" z. A0 g3 ?Serial (VIN) # -
! @5 u/ d3 F, [Plate Number:5 Z7 o. p+ z/ k5 X' T; W7 h+ F
Driver Name: (called driver B in this document) |1 m. e7 R* D. d
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A./ @0 q" T5 s* U& @' h3 b
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The driver B has paid
$ h( n' D. T+ o" E1 k1. Bumper repair: $
% W- \% B2 c) L7 z$ P$ c3 Z. C2. Other Compensation: $
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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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Driver A:: g* m7 h( K q& M' d+ G- r5 D
^! V+ D \6 I- aSignature Date:3 j5 h/ F* C, O. p" X ^
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+ o$ C" G( g$ l( ^+ o$ l4 U( c3 E, |Driver B:2 s, [4 Y1 X7 n
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Signature Date:; Y" `1 S+ e$ p n/ E! D
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+ i5 K. [: I9 l7 r4 O5 A. U0 J9 IWitness:2 t: w+ g" e; |% i5 N
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Signature Date: |
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