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这里有一份
自己酌情改改就可以了。+ _6 m. E" j- L, P! @3 c7 m3 L
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Settlement Disclosure! ^% z5 s% n! d" Z& L# }" {& _: g
Final Settlement
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Year -" ~* v/ B' V/ }
Maker/Model -3 Z6 h8 Z' A/ L, ~
Serial (VIN) # -
8 }" P @# \( e0 A$ e1 J% Q1 i/ c" ePlate Number:
; w! y/ s* h q' e* J) O/ U' qDriver Name: (called driver A in this document)* r' d0 z& I' O, x$ p+ ~8 I
/ \$ m) M' z# n8 }, tCAR B:
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Maker/Model –5 j/ [4 q! A5 n( b+ D! v5 c8 C
Serial (VIN) # -# U1 e. m7 a* {6 N, M# O
Plate Number:
6 z1 @# C' F8 m; G0 a! HDriver Name: (called driver B in this document)+ y" c" A2 f! }) x; @, B1 y
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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 paid9 O( [' k4 E7 B L
1. Bumper repair: $
, A; R+ I" Q! V; }( M7 c2. Other Compensation: $9 D$ `, e% I+ X- o6 F
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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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" h6 n& p0 s4 t2 o/ ~% E0 @- xDriver A:7 t, d- }% W1 {1 h9 `0 M
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Signature Date:$ S) Q! e( n: L/ p* v3 o
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$ l, t6 W+ I; T3 C, FDriver B:
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Signature Date:) y1 v/ a: W* D, O* N
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3 p- J- \* c7 v9 vWitness:# {2 ?" ?1 C/ n
$ n% W- [ F0 uSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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