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这里有一份
自己酌情改改就可以了。: M6 X g3 B: q3 n
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Settlement Disclosure
3 @* h( F! X. d5 DFinal Settlement
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/ b1 p. ?& ], ?! nCAR A:
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Maker/Model -! {& @) Y0 J9 ]
Serial (VIN) # -2 c* a" S7 ?' `* u4 \
Plate Number:
) T! ~% S( A. M% j1 K. lDriver Name: (called driver A in this document)
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CAR B:/ C" }* m7 t" r6 K+ g
Year -9 U$ F) {% e" ~/ I- M' O/ F) q
Maker/Model –
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* m, u% C, l$ ]: P' h$ l) OPlate Number:3 G* P' q7 M9 V n# T3 I% j+ t
Driver Name: (called driver B in this document)4 h# ?" m4 I B, j- A
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid8 B+ X" P6 P3 R0 o* U# D
1. Bumper repair: $( g9 K, s* L* h% Q1 j
2. Other Compensation: $
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I' m# f- Q J9 v6 G4 G- X3 p* \# w- Odriver 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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; a6 c6 w1 C" ^Driver A:
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; g% y; l9 W( e1 d$ p3 z8 dSignature Date:
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# w6 n, h* @9 vDriver B:4 N6 r3 x( ~5 g: p
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Signature Date:- _' P5 Q3 v2 j; F) \+ U
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( @' ?& u7 p) U" k% [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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