 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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% }5 _( o7 \% B" M. P# K0 Z: HSettlement Disclosure; o/ [: U; Y6 Q
Final Settlement% T5 s6 m* C: D! |' a0 u, `8 g3 _
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CAR A:1 J }4 d: Z7 u' a% K$ R+ |
Year -. t: b# z2 k% H) K1 u0 w# P- D
Maker/Model -, S* B2 N6 f" m
Serial (VIN) # -& m! }/ P# X5 J4 B) C
Plate Number:
& U& l1 D) T w8 b6 DDriver Name: (called driver A in this document)
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CAR B:
, ]4 { G7 p0 mYear -
5 ?+ D, x, h2 f% ]Maker/Model –
% H4 n& ~4 Q' S- |" `; ASerial (VIN) # -8 D7 d: e7 z1 O' o, T
Plate Number:) H6 i' q- s! |0 N N7 V! s5 n
Driver Name: (called driver B in this document)) S C( k) u; E; }3 x
$ a$ x: @- A$ g, d7 lIn the afternoon of Nov. 7th, 2007, car B hit the back of car A./ r B( B1 O+ _ ~5 d8 i
0 ~; t t2 E2 ?The driver B has paid9 g% T. D+ i7 a8 t! _1 h4 U9 r8 x& M
1. Bumper repair: $
# g' }7 G$ \' M: g, _' {' ~2. Other Compensation: $7 ]$ z$ l3 Z, L
* J l, Z( r" P# h1 q" Y8 I( M$ jdriver 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- G2 u0 U7 `. I3 t
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Driver A:
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3 Y" B8 M+ p. s3 J$ c: l ~- ZSignature Date:
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6 s# V- \: \" c3 d+ s# zDriver B:
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! [$ p1 m- s( d+ }Signature Date:) ^0 m+ Q" v: u) R0 K5 n; X, p
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Witness:
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2 o- K/ F3 S. w, U! \. M) Y" BSignature Date: |
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