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这里有一份
自己酌情改改就可以了。) }& q8 |4 I6 } t* | @3 f
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Settlement Disclosure
! V5 j3 Q( L- {* nFinal Settlement$ K+ d" {( O, b3 ]) ?4 I
2 R9 l1 \, s, o! A0 A6 D; c$ U- `CAR A:9 W6 T2 o% U3 z5 p! Q7 u
Year -
! M: x I3 F- z+ }, {* a$ YMaker/Model -
4 n$ y' j8 R& s: KSerial (VIN) # -4 C+ W f+ i, E* L3 v5 H. s3 Y
Plate Number:: a1 G5 K# u9 t$ X
Driver Name: (called driver A in this document)
+ n1 [4 B) ]6 }/ A. h o. l2 j1 @% _7 F
CAR B:
; `3 L- c: e' Y/ iYear -; Z) g, l* o' L7 Z5 a6 S6 `7 q4 b
Maker/Model –
9 F7 t1 y0 H- }) r& _; W* a7 O" t3 jSerial (VIN) # -$ V% \. }& n) `# x% {' x/ l: X0 u
Plate Number:$ r d4 T: v. u
Driver Name: (called driver B in this document)* o' ]" [* N* L1 z* I* Y$ u
# i/ p: [+ }) ?+ \In the afternoon of Nov. 7th, 2007, car B hit the back of car A.. v) W; f4 c/ b! s
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The driver B has paid
" t) M' X3 L' T1 x g: T1. Bumper repair: $
E1 }: B0 D" S" ?' X2. 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:) C6 M7 j3 [0 x# s& l) l! M' v$ m
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Signature Date:
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4 `# n' ]- {+ g* ]" n, FDriver B:
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! K8 \' D2 f, V, R$ ]* O" h2 i/ `Signature Date:, \0 k3 a7 l4 f b5 E* W- h/ ?# |
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9 W$ _! E4 H) U* y9 w( G! gWitness:
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Signature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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