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这里有一份
自己酌情改改就可以了。
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Settlement Disclosure
1 n) O v8 h k) ~Final Settlement4 a0 N6 W3 \8 D0 O3 W/ ]
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CAR A:
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Maker/Model -
2 n$ `; g2 ?! sSerial (VIN) # -
$ Q& ]9 T% @ Y# }' d( c+ U% X' TPlate Number:
" n) a! E9 F4 O1 m7 H0 e- GDriver Name: (called driver A in this document)
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, U% W& A- R2 d kCAR B:
( V" e& I! }- l4 t8 a; H' cYear -
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Plate Number:- Y, D9 G& u: j3 Q- h
Driver Name: (called driver B in this document)
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0 r, h; t7 t9 p, TIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid' U$ p8 P4 A4 a4 p
1. Bumper repair: $
$ t1 Y& q0 y' S6 r: V# p2. Other Compensation: $- `7 M; L& H& H. M
' J2 d( t0 I0 }1 T9 a. U Ydriver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.7 Q# P, L# H$ m
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Driver A:
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9 S1 ?" P) Y6 M5 LSignature Date:
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Driver B:% G9 s% @6 ?" H6 ?1 H
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Witness:
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1 q1 O5 l% n7 [9 V" x$ cSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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