 鲜花( 3)  鸡蛋( 0)
|
这里有一份
自己酌情改改就可以了。
( R7 `, b R7 |+ M! I7 y% r6 e* M/ d j* F
Settlement Disclosure
0 w; i, t, N" H( N3 ~5 bFinal Settlement0 X8 q6 U" x2 t6 d
* Q% b) u6 [+ `" K9 H5 m9 D" y; m0 sCAR A:: W$ P9 \6 b9 E7 w
Year -
3 y7 }2 k, v, p, hMaker/Model -
& ], z6 e2 z; I. f0 f6 I7 r3 rSerial (VIN) # -
_ x6 a: h6 pPlate Number:5 G7 a/ p1 X+ I ~9 ]" g7 n' N2 c) {) o
Driver Name: (called driver A in this document)* `+ y; m" F M
9 e5 e1 @( |, O% q- vCAR B:+ t% e% T! S, {
Year -
8 q& D) J/ ]4 L- ?Maker/Model –/ N3 _- D/ q8 h5 t6 Q6 K# y
Serial (VIN) # -
6 {$ f. f& t% q0 N( yPlate Number:9 v9 @0 S) g% d) y9 d, V2 N
Driver Name: (called driver B in this document)& _( E7 W" N+ d u4 f
2 b8 W1 g+ W$ y4 L2 a$ g' ^
In the afternoon of Nov. 7th, 2007, car B hit the back of car A.5 g2 r; s' J% B4 Y
3 z# K7 M3 c. @' K; U/ |The driver B has paid* I( n0 R3 n& H: j* K3 L# X
1. Bumper repair: $
- A, l& D6 v8 Q9 {) `+ l3 ~, j' A2. Other Compensation: $0 C! }0 D! E6 ?! K$ c1 ^5 s
" r9 I. n& {/ V1 g+ O6 p. Ddriver 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.
% v6 r, U$ J* T- O3 B. [
4 E3 u9 h8 ]# S4 }2 N* SDriver A:) T8 x( r F" ?! P$ k
. a6 y# @/ L' p. U
Signature Date:
# f9 J* i0 Y% {( m7 _4 O, I2 L D2 f+ q8 J5 i0 k# y: P1 m# Z
6 c0 i* }( v o3 z6 x2 |* y, I, U
Driver B:5 U: q" t9 m1 S: _; w; h5 \$ X9 b
% H1 E' m4 n9 u8 H
Signature Date:
: S s: W4 y) p, U Z0 g6 v8 L) W; S9 T, [3 Y8 A+ J- i
5 b! j- Z5 u( \: C
Witness:
! I' k6 d/ f$ O$ S3 v
( S. C- {0 u/ lSignature Date: |
|