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这里有一份
自己酌情改改就可以了。
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Settlement Disclosure
9 {( T/ J: t; |Final Settlement! g: E) \$ S3 f" ~
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CAR A:
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4 ]. x* m8 F4 bMaker/Model -
) m4 ^8 B5 `* @Serial (VIN) # -
' z" ]% F4 Y2 O4 {Plate Number:/ }# m5 ^' ^- Y6 S4 f
Driver Name: (called driver A in this document)
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4 M' h$ F# }: h: ECAR B:. P' L# b* o9 u2 b8 Y2 V
Year -
* H9 _# G& c1 NMaker/Model –
0 j" ?0 k4 q# t. [, fSerial (VIN) # -
% `0 X& Z. ]8 V/ IPlate Number:. P- ^* D9 e' x1 ]7 W
Driver Name: (called driver B in this document)
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" E* m' p3 f- F" cIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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7 i$ y; F4 ?& AThe driver B has paid$ L: y r- O7 C: v8 z
1. Bumper repair: $
8 ?, l% A2 d4 Y1 s% ~: b6 n7 t2. Other Compensation: $7 \7 e% S/ Q$ U* U# D9 ^( l& u3 D
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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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Driver A:+ e9 ~" L# G" `. S
& T6 w2 ?! i3 T9 H8 K4 A7 WSignature Date:
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6 [6 q, t5 J8 n. c! {: _/ j" N. ?Driver B:8 {# O$ O& n$ T4 }% g4 E5 ?
/ }( x0 T$ e2 @: J" tSignature Date:" ? j! T& w3 ^, s3 L& @# M3 V
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( T8 ]" Y: p+ L, _- nWitness:) ]9 ]" g: |5 Z- v* O ?
2 T8 ?+ E0 v& ~Signature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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