 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 Disclosure3 y* I3 x0 S) f. u- E
Final Settlement3 v, Y2 Z9 {/ B2 C, V' |
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CAR A:- z/ u& W9 s) [& ]: K
Year -$ _4 o" K: N; Z
Maker/Model -! |$ ]6 D+ p& L6 Z! K8 o
Serial (VIN) # -7 L4 z4 {: M6 |
Plate Number:
8 _6 ^" T. R: h0 A# oDriver Name: (called driver A in this document)6 `4 R4 M$ S, V% G8 M, v) C
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CAR B:
5 w3 ~* J D! ?/ F/ u3 X% ~1 mYear -
0 ]6 L. f/ ]: m! P) kMaker/Model –% [; d# v' p9 k+ K3 \- |
Serial (VIN) # -
\, Q( Q3 q' d1 ], pPlate Number:
, e+ H% L; _ a# I$ r& XDriver Name: (called driver B in this document)
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid
; @ g+ ]: ] i" g1. Bumper repair: $
: U! _6 d2 N( V" \" n* K2. Other Compensation: $& F0 D# I( T# Q9 w- M% d
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driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.* C/ I! k6 ?. E6 B0 l+ j
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Driver A:
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Signature Date:, E, v8 m; U$ j) t7 D
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Driver B:% z& ?6 h; N: T+ {; ?7 H$ u
1 \4 i5 b+ ^* e2 F, r% NSignature Date:
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Witness:
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& y& |5 \6 w* G7 z: J( j* gSignature Date: |
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