 鲜花( 3)  鸡蛋( 0)
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这里有一份
自己酌情改改就可以了。
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Settlement Disclosure6 a( F5 o: G& S1 V& v2 w# U- F
Final Settlement5 V5 q0 i. Q! r0 ]9 l6 b$ Z4 R
5 p: o' l9 j& z QCAR A:
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Maker/Model -( z5 h4 ?" C) e/ h( p0 F5 ^
Serial (VIN) # -( [9 A# G) b) f! N( l2 L
Plate Number:
! l9 T9 z& _# }Driver Name: (called driver A in this document)- s* e& N0 j, |' Y1 z" J: D9 g
5 r, Z. h# f/ z V6 T* |CAR B:
$ c- h# B) ^1 X" BYear -4 a- \& V, }+ T" `$ p3 e F; U) [9 K
Maker/Model –
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Plate Number:
" r2 X( C" q0 k- f- Z: IDriver Name: (called driver B in this document)6 O1 e* I2 v/ ]6 ~
3 o; K( S( L6 b, FIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid
" o( N" J* T" }* @. F" x# x" M( g3 }0 O1. Bumper repair: $# D2 E, d$ I: g h' V g
2. Other Compensation: $
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( _: \0 F* q0 ]$ C4 c& r7 k6 {: }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.1 m$ L. n6 a7 ^ ?0 O
7 v& e: E' ^) z; o4 wDriver A:
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Signature Date:
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3 Q- Y3 [; k% Z N! \2 EDriver B:
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' L: {3 Q+ T i1 C; G; hSignature Date:+ y3 {$ ~4 P# R; d
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Witness:# t# r' H+ ]% J7 _5 y
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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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