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这里有一份
自己酌情改改就可以了。" P8 D, s% w5 k! \) C( o% O' u- I
' F4 D9 R, @. i: d; x+ YSettlement Disclosure
6 a d, o$ f y7 Q0 A) c" ^2 UFinal Settlement4 n0 ~ `; y) ~) \ Z, V6 n1 L. w+ Y
/ v8 s' u& r W( c( ^CAR A:; M' E% M2 I' w1 S5 f8 x
Year - m9 j5 ~ C0 J' N7 D' Y% F
Maker/Model -
! Q1 b: }5 h% b5 |! F s KSerial (VIN) # -
( A/ s- u% W+ Z; l$ BPlate Number:
8 ]4 T' @3 S; P+ R8 H( X# NDriver Name: (called driver A in this document). G/ m3 M0 C- a& ?7 G
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CAR B:3 V% U6 Q4 Q$ w$ ]
Year -
, ~( Y+ B' R. q: V$ ^" D+ ?Maker/Model –- B6 o2 [! p; C4 N- J" w/ D" ?/ \: g
Serial (VIN) # -3 c# n3 f N+ f+ M: K1 y2 ~. a
Plate Number:) x/ I6 s" Z6 j, B* L
Driver Name: (called driver B in this document). g8 c9 U# W) x
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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 paid5 I( M, T% E6 ]+ j
1. Bumper repair: $
( w7 h3 a0 g; C' E5 U* g- s* s e# s% K2. Other Compensation: $# u' { L6 O3 n8 n; P, @' J; b( q
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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.' Y- k+ j. |' R" X
; ? D* r4 T3 YDriver A:
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# p3 Z( o0 g( v- @% tSignature Date:
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Driver B:
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9 ]+ ^! ~& F: X6 Q5 lSignature Date:) B& }1 R9 m+ L7 r0 L, q9 s( L
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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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