 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。! Z# C+ X& z/ K: `& x; [0 C
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Settlement Disclosure
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1 r x; U" }$ k. vCAR A:
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Maker/Model -, R' b/ t# i& R% \
Serial (VIN) # -1 U1 p6 q$ e; c8 [
Plate Number:$ H3 c! C! \, {0 h
Driver Name: (called driver A in this document)
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; x C1 L, g: E5 KCAR B:6 q1 x5 b% ~% L: a, O0 N I
Year -0 m6 ~: Z- M2 o! ^4 ?
Maker/Model –
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f. u$ K! {* c+ VPlate Number:5 g4 c) C( ]' H' {2 n/ O
Driver Name: (called driver B in this document)8 n6 v0 @- C4 ]9 T- q5 U
4 H0 ?" f# Y( z* S/ f/ u! z* F* p1 u- FIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.6 G9 l4 M4 i: S. X( Y) \: d3 _
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The driver B has paid K9 L* ?* i/ Y. c% F6 N( v6 i, f
1. Bumper repair: $
- `0 @/ ~2 l4 K& P* U2 ]2. Other Compensation: $
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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.
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Driver A:
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0 z+ N1 f5 C9 C- _& x! v2 ISignature Date: K( h+ z2 N. }; W& Q6 x
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Driver B:" g2 a7 e1 E2 u' ^7 g( P, o
: C; m+ I- }2 Z: w, Y( ZSignature Date:
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Witness:, U* F( h, m1 W g ^
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Signature Date: |
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