 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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* f. G. s. }4 u) y7 ]5 bSettlement Disclosure7 {( a- X5 n2 K5 d6 b
Final Settlement2 y* L5 k4 v7 \1 \1 j$ `0 _: \, `
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CAR A:2 X8 k2 ]( F1 X+ b5 v) `
Year -
# b. }, i# q/ w y, O; SMaker/Model -
# g3 Q; ?+ H& L/ [* z+ |Serial (VIN) # -
& V* ^1 M* t4 P9 v' G- \! J V, cPlate Number:
1 s, }. g8 V/ bDriver Name: (called driver A in this document)
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CAR B:1 A. w8 ~" M. W1 Q0 f3 e
Year -
& {. l) f5 e+ ?( |Maker/Model –
9 z8 ]' C0 ~! s! O9 Z* RSerial (VIN) # -
* n6 z i/ l/ o: @9 wPlate Number:+ ^' w" R. Y+ n0 N
Driver 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.( S$ I/ @" u0 ]
+ g; i* x7 S+ }3 x( {# DThe driver B has paid
0 l B2 W$ x! N5 p* _5 N" x+ Q1. Bumper repair: $6 Q5 U5 ~& p: K: Y( o+ e
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.* O( z+ r9 z' q8 t; `, _
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Driver A:
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Signature Date:
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, x- {7 A& e: w! b6 H QDriver B:: u5 |4 A5 s% q7 o, J% E
- r% X1 C% y I( H$ zSignature Date:
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& e7 I, t/ u2 `Witness: ~8 ~5 d4 l) M8 F$ [9 C* N
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Signature Date: |
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