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这里有一份
自己酌情改改就可以了。1 \% m8 r) h, ~
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Settlement Disclosure
! ?. j6 H$ \+ Q& qFinal Settlement
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& Q3 R: I+ ]3 E |. aCAR A:
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/ m! D# A( I- PMaker/Model -
S8 m- f3 }9 z/ l; cSerial (VIN) # -. K. @7 u' q) P# k- w
Plate Number:
6 G* F8 J) e: q0 jDriver Name: (called driver A in this document)
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* @1 i- D _/ T% V% E* c" |$ TCAR B:" `0 R3 t3 R. V. ]- V# B& d
Year -0 y8 o6 K: |. W" y& j7 a. P- @
Maker/Model –6 _5 ?& A' ] g1 [7 a0 F; J
Serial (VIN) # -
% q( H! B, I6 Q+ Q: j8 IPlate Number:1 b# G" Q6 W: V* K
Driver Name: (called driver B in this document)
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1 f8 D! M$ T' b: \) tIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid; _; X1 a- t, N
1. Bumper repair: $. B& g3 r* P% }, v3 `0 g8 _
2. Other Compensation: $
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/ E5 _5 t1 \6 c/ b1 e: zdriver 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:! d2 a5 i) _0 R9 ?/ J: q ]
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Signature Date:; R+ y: l$ ]% ]4 r* g
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- `, H% S8 [. X8 D; J0 GDriver B:
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: V* q3 f& J* `Signature Date: N% f A6 u0 m/ z g
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1 t1 i6 e$ o% q5 m: b7 r- eWitness:' i$ y8 p, E( y; p
! z7 x1 h# P) _; [ A1 ?Signature Date: |
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发表于 2008-3-11 09:16
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