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这里有一份
自己酌情改改就可以了。# a: e) R2 {% k6 x$ Y& D' c
: P$ s+ g+ K3 e8 u, d+ w+ ySettlement Disclosure- z, P8 b! `( O8 N- O! r6 G
Final Settlement, v, \! p/ N/ t3 I) n0 G
" F0 J' g. m4 g# ]6 O9 ?. yCAR A:
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Maker/Model -- [( Z- @3 h" Z$ Q2 e Q8 g
Serial (VIN) # -+ p8 Z+ c \. O4 Y$ y; v" e# f
Plate Number:
. }$ d2 q& p( n9 y" G% ZDriver Name: (called driver A in this document)' s. ]% C! k0 `/ F; s
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CAR B:9 e$ E" C: Z) q+ J8 w% b
Year -
0 _8 {4 [% c0 u3 @, l6 u" pMaker/Model –
9 p a$ U1 h# @! Y: A) wSerial (VIN) # -8 j- E6 s+ i4 E; z7 V/ t
Plate Number:' j \! p t9 P- e0 m5 ]- i p( m" B
Driver Name: (called driver B in this document)* H, _! @. a1 a# N
, l9 c9 e# C. R! `. V' V5 D5 rIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid
; U, k9 t% H7 E8 l8 q+ E+ I, ]1. Bumper repair: $3 ~, ?0 S2 @. Q# T
2. Other Compensation: $6 H' i3 ~9 R7 [
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driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.
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, H8 p0 T! B& f; S+ r1 ]Driver A:
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' q& ^! K& |& Y. T+ qSignature Date:
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5 b; P. p! \ b/ m$ N, [Driver B:* V- z& n* K/ d. e! a/ r. {0 R
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Signature Date:
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Witness:
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6 U+ r' {6 l1 o" `6 Y1 bSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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