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这里有一份
自己酌情改改就可以了。
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" D a- |# p7 c: _) x0 SSettlement Disclosure" R1 {/ n4 x _) I4 C1 W: t
Final Settlement! D- a1 V# s9 W, ~
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Year -6 |, o" F) l. ]; T' x5 b+ T& d
Maker/Model - B! A, m5 J* B% L$ o& }, h
Serial (VIN) # -( u5 l5 H) r, T0 t+ g
Plate Number:! v b9 q( W4 C6 \
Driver Name: (called driver A in this document)- e4 R- W4 r* w% u" m' p" k
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CAR B:4 S% D9 V2 T8 V7 N% p8 l. x' S
Year -
. R( c$ U- R% X! m* f0 z! yMaker/Model –" N$ A- p7 N @
Serial (VIN) # -, a' k, m7 _ v; w0 T$ V( T3 x8 {
Plate Number:( E/ n- S5 ]# h7 ]
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.# }6 t; z& n+ g. A6 y, b9 G
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The driver B has paid
8 @, J* K7 O; h. }# [1. Bumper repair: $; O6 i4 F' h1 D0 i
2. Other Compensation: $
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; m9 g( B6 W) x! T( {4 ^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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+ R9 C. x/ G4 _. v$ ~Driver A:
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Signature Date:! g5 [/ a" Y( ~" d/ I
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Driver B:) X$ t! `0 O* n5 T
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Signature Date:
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3 U5 w/ Q5 f1 P, ]0 rWitness:' S& i3 ]. ]4 a0 J5 c: N5 t
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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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