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这里有一份
自己酌情改改就可以了。
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9 e, b( u# {' O/ USettlement Disclosure) y" h7 s6 [: G
Final Settlement7 ~- o) x) `; m0 M1 P
1 {3 x0 g) l' d: T( _5 P' P* m/ [CAR A:
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Maker/Model -7 h! j9 P) B+ N# F
Serial (VIN) # -: v2 v9 }$ ]* g$ {' ^- K
Plate Number:
( ^+ v# ?2 F6 mDriver Name: (called driver A in this document)4 a9 Z5 m' W. ]8 a
4 G7 ^* E& |* P/ U# h# _CAR B:8 o1 k# p8 W0 |
Year -
& }- e3 |) C1 [7 l* X+ z7 yMaker/Model –9 t$ k9 A' z3 \/ s% X
Serial (VIN) # -
9 r. ^% A- B, F+ KPlate Number:% D Q5 d: N) z! P' Y% F
Driver Name: (called driver B in this document)
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; K" z1 e( {! ~5 z; j( \In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid
3 x6 m1 ^+ h/ k! \+ X5 D; ^1. Bumper repair: $
. e! w2 x- H6 Q& O+ o$ ^& H9 |0 r2. Other Compensation: $
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; m2 n2 g) }8 }: p' {* W- n* j0 E0 Edriver 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.7 q4 g8 ~0 K; r n! P
6 w' K6 X; ?' K0 [. wDriver A:9 ]4 g9 m" U, D
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Signature Date:
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Driver B:+ \/ V% A+ g+ t' u# f8 n2 ]8 X
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Signature Date:
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* s, M( n; [9 [) zWitness:
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' m4 ]. ~# G* a H( v( h9 LSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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