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这里有一份
自己酌情改改就可以了。5 F4 k& S1 b, p6 }
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Settlement Disclosure
- X( R3 V9 j# e5 OFinal Settlement
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- E$ i8 x( E/ E3 j) rCAR A:& Z( V, q+ }1 E
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Maker/Model -
/ P, d# E7 D4 L' j" C/ CSerial (VIN) # -
+ T7 W5 {: ~4 `) S: a% H* e0 gPlate Number:
2 j; t" Q, P3 e4 V' E7 R7 sDriver Name: (called driver A in this document)7 b8 |5 d$ W( B. K! w. o. j
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CAR B:
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Maker/Model –, i0 r7 t3 g1 |
Serial (VIN) # -; l% n( h0 B* x* V# n+ _$ y
Plate Number:% q8 V3 i0 ?' c+ f" }% T
Driver Name: (called driver B in this document)5 i3 g+ \ @5 O1 Z
5 k6 O' J! p# K6 n- x fIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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9 Q2 M6 S& V0 I0 eThe driver B has paid
& f& ?' x: a; R" F& a, K1. Bumper repair: $
4 _" ^1 P4 h/ |) Y0 u2. Other Compensation: $
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4 @& l9 j( {, K! S e& i; [+ ]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.2 b# l% e7 O; F+ @: Z
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Driver A:2 Q* i& c9 K" A- E" @3 N
+ ^( l7 [# ], XSignature Date:6 B) |" Z. I. p3 A" d; w5 T: U
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Driver B:
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) J6 \! f% p5 }Signature Date:
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: X* b# L3 G# vWitness:6 }) w! N2 i+ p; v: r
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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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