 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。% x7 d8 x! e9 S* I% I5 D
& S3 z: L% S) OSettlement Disclosure) S' R7 ?8 P# |
Final Settlement3 r) Q, H! r8 X9 c& U
/ v# c' u0 l) v1 dCAR A:7 c9 m4 X! m1 n( b0 z' g( R
Year -
! h5 s( ~! Y6 fMaker/Model -
1 b% V/ |; v9 p* ~" j) y O/ wSerial (VIN) # -
$ U$ s0 s) L. E; X0 ^Plate Number:1 K( J P' g7 h T
Driver Name: (called driver A in this document), h8 ?8 v6 R2 o" f( G
9 m9 |/ q* u! n: i+ D1 e" KCAR B:
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Maker/Model –2 C: Y. O% D" X2 G( a% e% \ F
Serial (VIN) # -
- @% c: V/ k5 g1 Z, CPlate Number:
: Z5 _( b5 F4 Z+ v E+ XDriver Name: (called driver B in this document): q7 B, z F9 T3 X
8 ~0 G9 B6 |; a( h& VIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid
5 N1 m8 P5 Q/ n, M( o; W J1. Bumper repair: $
2 \8 U O' j# @! t3 F9 L2. Other Compensation: $
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8 q% F6 t! j4 v' D# s 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.2 j+ w1 F; Y/ q7 G) ]
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Driver A:# }- W" h& r" x4 }9 P2 C
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Signature Date:
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Driver B:5 ^. o) {$ A4 ?) h$ y7 L7 D
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Signature Date:
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8 w' O% f* q8 C) K v# V* G- zWitness:
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% Z# _4 c, Z- G9 u. aSignature Date: |
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