 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。; K2 k' C, Z" m9 o. ~
* C7 ]$ I9 y: M" {5 D8 B. {Settlement Disclosure
9 v' o1 }/ v8 Z! L& KFinal Settlement3 F0 z& ~# B( D9 R; L. P2 T
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CAR A:9 J5 e. o& Z& a
Year -
- Q- G# Y) q5 a+ j q' pMaker/Model -4 r4 ?1 C1 H+ V$ w* f4 ~2 m* h
Serial (VIN) # -* G7 m$ Z0 j8 g* S$ H# q3 |
Plate Number:
& l5 M. N/ S) s o1 |0 uDriver Name: (called driver A in this document)
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CAR B:* F& q) s6 {% u! W
Year -
0 C" g1 B: \; \Maker/Model –
; X' `3 ^& }; lSerial (VIN) # -
" z- n' e, G# k2 QPlate Number:
6 ]( y! r9 B, C9 f/ u0 GDriver Name: (called driver B in this document)
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3 m( o9 J8 j F9 g- _$ MIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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5 H0 z9 E1 H- R* ]The driver B has paid
; Z3 O' G7 I4 P, U3 H* k( \4 ^9 R1. Bumper repair: $
5 F, R/ l a. V, F; B/ `' P# Q2. Other Compensation: $1 w( U! K7 t8 h( G" n
2 G6 G, t1 |' b9 R4 d8 Odriver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it. u& a/ W, I5 i5 ]1 y8 E/ K3 d
) j- |# }; Y9 E4 R% V& l$ }Driver A:
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Signature Date:6 f7 D' H& A1 K' @: k6 O, q
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7 m1 y; ^& N& UDriver B:- u b/ C2 ^4 b3 M
/ q; {' n1 Q( e3 j3 S/ ?: x% oSignature Date:3 [" g5 m" y+ O0 F% Z/ D
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# N: S C' V8 [6 H, DWitness:9 O5 z$ j$ `, D5 ]% N5 E# b) l6 L
]* e6 ?5 m. u! GSignature Date: |
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