 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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Settlement Disclosure4 }2 @1 R% _3 b4 a% J Y
Final Settlement. \: W" G! }. S( F7 J. Q9 V, V
& V! T; c; a& {* r2 K6 g. @CAR A:
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Maker/Model -3 D0 m3 K7 ~9 G l
Serial (VIN) # -2 V& a1 C1 Q0 J8 v) Z. f& f
Plate Number:0 d7 A2 B% u- p" Q) w) J5 [3 e
Driver Name: (called driver A in this document)
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CAR B:
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Serial (VIN) # -
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Driver Name: (called driver B in this document)
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" h4 l& U# @& l X; NIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid; F; b0 J m' h" ] j( Q
1. Bumper repair: $, p/ J. J. f# }6 V4 i+ `
2. 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.! s# N/ `/ d. O* e! @! R, j) ^
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Driver A:- \/ ~: p- r" z3 m0 @8 w' s5 v
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Signature Date:
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G( S5 f# S3 q( s5 a* X% DDriver B:
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: x1 {6 J: C% }2 W ]( F4 L$ GSignature Date:
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( [6 z8 O* W7 x4 \Witness:1 [& p& k0 p1 k3 w& z6 P8 ?* b
5 U+ z( o+ l( T3 SSignature Date: |
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