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这里有一份
自己酌情改改就可以了。
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6 V7 l" U5 |) }3 oSettlement Disclosure
M' S- _7 b/ }* @. WFinal Settlement
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& Z3 R0 x0 E4 E; ]/ a: A% BCAR A:1 t4 ~2 t Q% m$ z1 N2 e
Year -0 U" i4 N# V& Q w
Maker/Model -
# d4 j9 v' A% RSerial (VIN) # -
) t( L2 `% L1 y) ^Plate Number:
5 U# K; i" ~* u3 s; H. B, }: [! ~/ lDriver Name: (called driver A in this document)
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CAR B:
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# k" ]! ?. K/ H* ?9 a: a6 {7 CMaker/Model –& j# u! R9 q& Z9 }* ~0 S' @
Serial (VIN) # -' \# T0 Q! @2 W$ Z
Plate Number:! j/ M- y7 b( {9 J8 }8 U
Driver Name: (called driver B in this document), y( L; |' U* s0 I
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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 paid+ a+ u% s" B' Q; n4 N' |2 C
1. Bumper repair: $
6 _1 p) [. N9 O2. Other Compensation: $
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1 m8 h: V! e3 ?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:$ T: u" B$ L0 O
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Signature Date:% N- C! p* g. i6 F2 K
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Driver B:6 S( m1 F" X8 ~3 h, H$ x
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Signature Date:. J' o6 ^9 Q+ H& f( Y) m {) Y( F
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, g* F e z1 @3 r; @2 V+ VWitness:8 }# Y( G1 s6 v 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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