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这里有一份
自己酌情改改就可以了。
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1 x; l+ P8 r9 |! k2 fSettlement Disclosure. w6 G# f; C& R U
Final Settlement' }/ | C+ @! h8 |8 X
* t8 B% c2 ]& y& D/ nCAR A:7 L7 H) G8 U6 M, G" ~
Year -
5 S' B" w: H3 [: C9 E7 ?Maker/Model -6 ?6 [* S3 \/ v5 v0 j
Serial (VIN) # -
0 R# H }9 B2 iPlate Number:* Y. x6 M5 ~3 }* o! |3 \, V) u& ]% N
Driver Name: (called driver A in this document)4 w' [( s' V6 m( N' ]7 N% J
3 x, l% j# F0 J( d9 J4 ICAR B:
9 z9 @: k/ H* UYear -- V3 I% P. A* O- E
Maker/Model –
/ w9 f/ `) x6 ]( ]& ESerial (VIN) # -0 ~, _. h6 P: i! ?( s0 m
Plate Number:
( s! A4 H* I H! m8 L* n& X3 }: {4 ]Driver Name: (called driver B in this document)6 D( _5 y/ K; I d
$ s+ F" F; h. R; A# f, R) gIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid7 }6 b" v$ V4 ?/ A; R' i! l
1. Bumper repair: $! Q8 j( X9 B* ~+ I2 K5 ]
2. Other Compensation: $# g$ i* \2 r# V, ]+ f
5 J8 a% Q2 R" H" Y1 A" F, a" sdriver 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:3 y! m" V. C! f' a' P
( ] j# u' ]* `7 t. h% rSignature Date:2 U$ x" I1 c2 x) e/ _0 S7 k" L
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" q& F9 R& t( W' E3 O% ^Driver B:7 \+ L* L, A. z6 n
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Signature Date:
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Witness:
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9 q a. N" F1 i: K! a9 R! dSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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