 鲜花( 3)  鸡蛋( 0)
|
这里有一份
自己酌情改改就可以了。' z% j6 N! A% t1 o
K/ E& e# ~7 q' I* \" ? r$ PSettlement Disclosure
* F, B# O6 w" {: g5 HFinal Settlement
% l! g4 X8 h4 E- E- m3 g& D' z* C" f! c' U7 |( k
CAR A:
' K4 `8 ^: ], m) ^ c$ ?6 \3 o& Q+ PYear -8 q U& K' I8 b
Maker/Model -
' F- ^) L+ w2 V* t) ^Serial (VIN) # -
9 _6 K! K7 W$ b! T7 QPlate Number:
a7 S8 p, P& e+ J' x' hDriver Name: (called driver A in this document)
/ n- c' f8 Z; P7 u0 `
2 A+ D: B1 s3 J' c) n% J: sCAR B:% v4 p7 N- Q- D; ~7 ]6 w0 |8 c$ j n
Year -. t. o/ k6 l" j5 T- I( z u$ w/ A
Maker/Model –
; N+ |, w! w( U# O3 ESerial (VIN) # -
Y, N$ j3 H, h: C: ~Plate Number:
% M7 a- R% G9 T- q/ ZDriver Name: (called driver B in this document)1 Q" ?" [5 s: r" Y$ r
, V0 Y& e5 y- N; aIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
0 f5 { O" d$ t: L
: Q5 G0 c8 y4 x/ YThe driver B has paid: f. L3 W) p; S3 X, |/ O7 _
1. Bumper repair: $
# P' L( G, s$ U: S2. Other Compensation: $
8 c% s' N" ^2 n! P% H
$ E/ H9 L5 O5 s0 H: Adriver 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.
* [) Y% u5 z. ~! b C* Q8 P5 ^+ K; s" N; c) d. S# b- O
Driver A:
/ S0 r& W2 X" S) n: w+ C; I) y! \6 u5 I/ P' V/ ]( w) c" k, Z8 C
Signature Date:' P1 I P' T. {7 w8 g( T& }8 g
: n1 m0 A1 u/ Y% S v7 u7 a; c
, q# [2 h7 l3 j8 d: C. e) i3 k
Driver B:, H3 ?' V+ [3 v/ X1 ^- ^$ r
2 x ]8 r: V P1 a/ N* e
Signature Date:2 Y3 c1 X5 N3 ] M
; N5 }6 |/ x& N2 c( n
1 D! {$ `$ M! Z
Witness:4 |; M& |2 m. A! j8 ?( L% F
1 m% M. f* F2 r2 w2 D# R- M0 wSignature Date: |
|