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这里有一份
自己酌情改改就可以了。% h; M2 J- l5 K t4 e' c2 Z
8 v/ {5 g; L! u! P1 t- gSettlement Disclosure
! c4 K& u% B+ l3 ?Final Settlement) B( U. v' M) U0 O6 z
$ `% D* o: x8 }; m- e! ICAR A:" Y; K7 s- W* y$ R
Year -+ r3 J' {" W% x) Y/ [) L
Maker/Model -
9 c. r# b t9 c# m. USerial (VIN) # - E( b' H0 N" y, e# {
Plate Number:
- t% C. L, g5 g4 t4 Z3 rDriver Name: (called driver A in this document)5 X) c, O4 |. u0 U$ v
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CAR B:! g5 N- f: m2 y$ a, s: L1 h
Year -
2 M1 I) J- y3 m9 R' CMaker/Model –# j3 R) _1 K/ ~! C
Serial (VIN) # -
/ P0 g. C( y/ ?" H _2 `: q KPlate Number:
% J( u7 E) c, P3 I# [$ |' W4 |Driver Name: (called driver B in this document)
5 H4 p0 g7 O6 W' o/ M: ?% z
* U, Y, L( P, W% R7 FIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.% e* I7 N* u" ?3 f. g" l) J2 }+ i
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The driver B has paid( V/ x; [( ~" I) A2 s" |2 |3 F
1. Bumper repair: $* h% W! ]5 |' \$ C. L
2. Other Compensation: $6 g3 [1 o7 c% T) J. ^; b
/ z2 g$ i4 G* @! C9 K8 Bdriver 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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) J9 ]" q4 |- d) |& E, U2 z; UDriver A:' H: i9 |, N& J( D
: m- V) v" S2 R) m( TSignature Date:1 u& Z- a" n& V% z2 c
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! } J, b Y$ O2 B
Driver B:& P; f: V0 F- m# l( U
, o7 T2 ]3 Z d5 ], M# pSignature Date:5 F# y8 n+ f! _: S6 ^4 N+ {- u
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0 ] A# I. }4 R* m; Y. s2 q, s5 JWitness:, @- W, O1 @* r- Q
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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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