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这里有一份
自己酌情改改就可以了。
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: D# `6 l+ t8 O. {/ sSettlement Disclosure
2 Z) Z& z A$ L+ H) PFinal Settlement
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0 `4 b) U6 E' E: B) P+ P( |2 VCAR A:
9 ^3 e" q, x3 b# wYear -4 l/ T2 K* Z9 o( m2 g+ M
Maker/Model -( d- ]4 D1 J0 W7 f0 G7 t
Serial (VIN) # -2 G( X% r9 s X
Plate Number:
4 y: Q& g7 Y' ]1 wDriver Name: (called driver A in this document)% b8 q7 P; `+ G1 L3 k
* @( `3 t' ^% p$ u% p) B
CAR B:
* q; X4 a1 m4 e @Year -
j0 j/ u0 v8 jMaker/Model –# ] r/ v' r2 P) [) t
Serial (VIN) # -7 {% {( `/ `, N; N9 F# x! P8 R' c
Plate Number:
7 P, i0 Y& [2 B7 cDriver Name: (called driver B in this document)
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9 I- ~& K6 u; H# zIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.3 V8 R5 U* m. d+ [
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The driver B has paid. s) Q" u0 m, l) z1 F! P7 ?. p
1. Bumper repair: $" l9 J1 d; B3 Z" ?: z7 D
2. Other Compensation: $
+ P* f0 L9 W$ A, Y) D; c3 Y/ R
) `5 l9 {7 {; l" [5 a& Qdriver 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.) L( L! q0 N, [ P m" u6 P/ X/ z
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Driver A:1 [# {0 g( g1 {$ J. V
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Signature Date:
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Driver B:* n7 l% o: i1 p% i* V- ^. c/ @
% }$ E9 |& x" j) i& r- ?
Signature Date:
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Witness:9 L8 n+ }9 r6 ~' V
" v$ e l8 c+ z& R" S" }2 LSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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