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这里有一份
自己酌情改改就可以了。
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Settlement Disclosure1 p% G: y5 \1 a0 N- T$ x" e
Final Settlement0 O8 f V! u B8 ?! O$ L% _6 @) n
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CAR A:
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Maker/Model -
% _9 V V9 ^! e6 iSerial (VIN) # -
4 e0 J! h- j2 j# r/ c- PPlate Number:
/ P6 f: O0 o4 Z2 M0 W6 b4 O2 f$ w0 xDriver Name: (called driver A in this document)
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CAR B:4 g* i3 W* W0 V
Year -
# m. }5 C/ O# yMaker/Model –
e4 s n4 ~* H/ q/ U ASerial (VIN) # -
2 Q5 o7 A! D }4 l/ C2 @Plate Number:
- L1 H1 d+ ~# l$ M( ~, SDriver 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.9 b2 @5 j! B5 m
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The driver B has paid
/ m2 Y! c2 \8 |1. Bumper repair: $2 L# X2 l1 g- B2 _6 R
2. Other Compensation: $
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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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! Q5 \- g5 p- m& |: W! w- e6 \- D: YDriver A:
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Signature Date:
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! o1 _ R: @$ {7 ?2 z% ?: F: ~Driver B:
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Signature Date:. W& N! y _( I. }- p0 N% N4 i
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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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