 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 Disclosure
4 N$ Y- N. ~/ m! b) v/ u2 i) v3 WFinal Settlement' ?6 L" W4 g3 z& `- U/ y
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CAR A:: B4 R3 q" ?: @! j- E
Year -
K; t% @. P9 W' D9 F+ a9 yMaker/Model -( |" a( Z1 T& h: I( I0 q
Serial (VIN) # -' X. m* d# o7 Z* v2 w( Z9 {
Plate Number:( ~1 |7 }) S" I3 `
Driver Name: (called driver A in this document)
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CAR B:' m( ]' B7 V$ P) V3 g
Year -3 n3 \6 g, w5 r g( ~' ?
Maker/Model –
3 _, |% G8 D* _Serial (VIN) # -
1 e$ H& ? O: ~) v" UPlate Number:8 l, q/ d: T1 N o/ y- M
Driver Name: (called driver B in this document)
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.+ a# V. z/ k0 p2 Y. w# ~. r4 U% C( x! _
" t6 W) }1 z6 H# V/ m' f; s- n% g* cThe driver B has paid
; r4 u4 \; A4 G1. Bumper repair: $
4 m- L8 `& p( r2. Other Compensation: $/ u5 \& E/ |" l4 o- U
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driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.5 {, J6 Y& s2 K% x+ {
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Driver A:/ Q! O( L5 h& S* b
& \8 }7 |5 a$ o+ H+ l+ qSignature Date: V& N9 m8 l$ n
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2 X# u# w7 t+ C7 v# f eDriver B:- H/ ]/ k! K- Y, I) k$ r
" a7 ?4 Z8 {2 K, NSignature Date:2 D3 E- F) z6 ?& X( r9 F
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Witness:, V! b7 L% W' P/ X/ a7 w! M
* P% p4 L0 h4 e: sSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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