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这里有一份
自己酌情改改就可以了。
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8 g. S \& N& R1 X$ u" ~( KSettlement Disclosure
# F% H; m$ m4 M0 l( x2 f: n) eFinal Settlement, D+ I# x- B( X u' P# P
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Year -# B# V0 V$ H) x; k4 i$ z# R9 b1 w
Maker/Model -
7 {; y( h' P8 V+ q& _' {* DSerial (VIN) # -( g/ t1 ~3 H. ^% ]+ X* a
Plate Number:# o, T, ^0 c3 a) l$ R
Driver Name: (called driver A in this document)
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- X2 C; z/ m$ R" _7 z4 H9 P& rCAR B:5 z U5 B/ {- v9 y& G
Year -
; r/ ?( [5 d% b; a, Y; ]' kMaker/Model –! [' m( w9 B% w
Serial (VIN) # -( [' @" I9 S# V
Plate Number:" w5 r% `7 x$ s u' l
Driver Name: (called driver B in this document)* j' K9 z+ R* ^0 X
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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w: v" [/ ~, WThe driver B has paid
0 ^4 q( j8 E9 @% d1. Bumper repair: $
! u8 p& S( L0 J! _: i0 {2. Other Compensation: $; h0 p$ S/ z7 P, {$ z
* z. P1 D! o% |# E9 ~2 vdriver 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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. U; Q1 F6 w) i P/ U' O% @Driver A:
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Signature Date:
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Driver B:
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Signature Date:
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Witness:
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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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