 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。: p# c7 Z$ Z) ] U- H. j
7 U% | N! U' ZSettlement Disclosure
* j6 r, w3 F) BFinal Settlement5 W2 ^1 T0 T* A4 Q+ S3 f3 Z1 O
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CAR A:
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- r! G* D! \+ y/ [, `Maker/Model -1 y k: q8 c( K( D Y) n* z/ d
Serial (VIN) # -6 W( Z0 e% F+ m9 o
Plate Number:
- z d$ |5 s+ }( ? m) J9 MDriver Name: (called driver A in this document)
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CAR B:
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7 d5 z3 D, a+ n& k* \! J6 YMaker/Model –
* Z5 S! J" Q& xSerial (VIN) # -; u- _# m* W' U" D% d3 j
Plate Number:
: ^* c( F2 V; i' [+ Q- mDriver 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.. u9 I" Z' w; ^. Q4 h/ T6 c
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The driver B has paid R% J$ J$ R+ w7 ?$ @! {) Z; Y& V
1. Bumper repair: $& c: g" _1 {/ k
2. Other Compensation: $% X$ |/ ^6 Q# [7 Q+ P- ^
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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.0 L; ]$ ~: r/ a4 K# A" L: @& T" F: F+ J
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Driver A:& M7 c3 G( j, \. o4 T4 B
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Signature Date:
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& J- T' ~' @& X" U: N/ Q fDriver B:- X; J6 {$ K9 d% b
3 Z% C2 s( F2 Z# gSignature Date:
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- q8 I& h ?' Y( B1 S& b" @Witness:
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Signature Date: |
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