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这里有一份
自己酌情改改就可以了。, `( ]5 A: \+ y4 t1 x+ I2 }
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Settlement Disclosure
& \3 _9 Y) ~ N) @7 HFinal Settlement
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CAR A:0 P* L! z" |7 P- f* |
Year -# Z7 s) F. Y" v# v) ]( H# r
Maker/Model -# i. E n9 `: A9 ^; e
Serial (VIN) # -/ U& D8 W: G0 M. f- c
Plate Number:
9 n/ K7 F& I Q3 W+ w ]' O2 KDriver Name: (called driver A in this document); U6 N' e" c9 I/ I, Q a! M$ i5 e% Y
, d. W ~$ Q( o$ Z9 f1 |8 T- wCAR B:9 d7 b6 k- N8 v' ` t8 c# b
Year -* @. e; M6 ^+ O5 O! _& V
Maker/Model –
/ Z" L9 ?2 v# H7 j, q6 e' ]7 QSerial (VIN) # -3 T" k/ h: [7 p/ X
Plate Number:# e. O3 ` k/ V8 C$ U+ D
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.
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* K5 Y Q* ]! T. I6 iThe driver B has paid
2 M1 ^2 {3 \. ]+ T& n. v1. Bumper repair: $- Q9 ~! {1 ~2 A
2. Other Compensation: $; @9 M# H5 a5 g1 x
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driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.
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Driver A:
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n! w1 R; T) s+ |8 B% v: ySignature Date:
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8 V6 }: x& t( M4 L j2 \5 DDriver B: F# Q# ?, ?$ F1 l6 T
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Signature Date:
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Witness:) {, O4 w$ q' I
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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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