 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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% a! Q! A9 P2 I: k$ @0 l8 P' gSettlement Disclosure
4 z4 w/ o" O) y7 ?6 f$ T5 HFinal Settlement
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Year -/ b- |' H/ X" I7 B; k
Maker/Model -
, |6 W' Y( `- b: P8 G6 ^Serial (VIN) # -
v# x6 K+ g1 t; w( nPlate Number:
; x6 \0 [1 _+ G: L2 ?& YDriver Name: (called driver A in this document)
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CAR B:$ R: Y2 ]' ~% w$ `' ]
Year -
% r" r# a. H# b- _( E4 w. s5 sMaker/Model –
, X$ T" K+ X0 d O- M, V% |Serial (VIN) # -
$ d; Z7 C8 }6 U# i% o( q0 ^Plate Number:
% U% D/ [( s5 ^! | YDriver Name: (called driver B in this document)
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* p) f5 N2 R, i1 [1 OIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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; b' n) O; i3 Z# dThe driver B has paid* r2 d' q1 h: H
1. Bumper repair: $$ i D/ J" M2 Q
2. Other Compensation: $! D7 d8 K6 o3 L. X2 H. h
1 B0 v4 z. Q7 l4 O: pdriver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.) t. J8 E" O# ]1 i
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Driver A:6 }0 V( D, r, n. z+ U; f0 \1 Y
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Signature Date:6 n, T+ Y& d7 A+ Y- Q! ?8 c
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( i$ P8 o, ^4 UDriver B:8 u. I" w$ {: s; ]( J
6 p: R8 M" M/ b9 [& cSignature Date:
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3 i0 p& ]" t2 a( `( K. ^6 xWitness:9 n% P/ I8 n* F ]
$ }9 N3 |& [4 J, ^: ]Signature Date: |
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