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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' p4 E! @1 d# E9 [$ O0 j: ?Settlement Disclosure6 z9 w2 G8 h ?7 X2 j$ W: X. \7 z, W) n
Final Settlement
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CAR A:/ c' r# r v2 } _4 d1 h6 t' Z
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Maker/Model -' N' H& A1 ]% y
Serial (VIN) # -
s* {0 A8 j/ y$ \8 X7 ZPlate Number:! `. }, T! G! @% P
Driver Name: (called driver A in this document)( z. q* i: g, o" S6 _
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CAR B:
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Plate Number:
0 i, w f! Z! xDriver Name: (called driver B in this document). P! g' T- ?. t, t) s
1 ?4 P; Y: y$ \3 X3 s) VIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid
& R- E% \( C7 z1. Bumper repair: $
& z2 h* l1 C3 Q2. Other Compensation: $
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! T# u9 i" u7 N: ?3 `, ]0 Zdriver 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 R' {/ u8 y0 x6 O: g0 j
' [, }+ Y7 c' G/ f) xDriver A:' R. R0 r0 s! ^/ C4 O
2 i% }1 Y# n4 m" P# DSignature Date:5 n3 A' D6 |3 u
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Driver B:" g3 U% T" u3 z" q
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Signature Date:/ K5 u+ L7 }9 S* P
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Witness:% r. W7 |- Q. @6 c& t
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Signature Date: |
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