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这里有一份
自己酌情改改就可以了。" v+ B; e! J- x0 s$ y6 d
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Settlement Disclosure
" U4 X' Z% r" H- a: m# K2 MFinal Settlement
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CAR A:0 j, @5 G# ?) e- j
Year -8 ~0 g6 f0 z. y: l1 D/ D) h" Y. N i
Maker/Model -
# y9 z1 `% I' \0 V& k# E6 R+ USerial (VIN) # -* r6 ^/ F4 M8 x1 H1 S
Plate Number:9 G7 n; t" j* _- ]2 [+ r
Driver Name: (called driver A in this document)0 M" B# l+ U/ b
1 V0 @0 Y/ T& i% z/ U a: cCAR B:
6 Q+ }) F! }# {$ g! G7 lYear -, W( [5 @; e' N" C- W
Maker/Model –+ _$ r9 y8 Q, M% T! Y a W% s
Serial (VIN) # -. o! J C% O& k" u7 Z
Plate Number:
. Z3 J5 |, Q3 j4 D: M. H5 v3 SDriver Name: (called driver B in this document)' O. x! ]- ]7 `
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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5 s# G! u* _. f* B0 o9 f( mThe driver B has paid5 V( `/ {% Z6 ?( J
1. Bumper repair: $
8 B; U& S% {) Y/ Q' | Z2. Other Compensation: $8 S6 b% e: `# O5 Q1 R0 W
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driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.- V$ O& r8 M' O, }
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Driver A:2 M8 {+ e' |, I
& W" H( E( `, p0 f/ |, {( V% ESignature Date:/ I% ], ^8 z# x3 y. p$ q z z
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Driver B:- |( g8 V# Z$ k; D, \6 M/ a7 G2 L
5 g( p* P) A8 ?3 M/ u" U8 QSignature Date:% F: J3 I2 Z, X1 u7 j
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Witness:
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7 j [4 u$ u/ i- t; }Signature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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