 鲜花( 3)  鸡蛋( 0)
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这里有一份
自己酌情改改就可以了。
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5 E" |1 [0 \6 s6 @: USettlement Disclosure2 s& ]0 |; \' {' J' J
Final Settlement0 {: `! A' n% ]# t7 D3 c3 s
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CAR A:, A0 u. s5 B8 F3 I/ g J
Year -$ I7 }6 i3 A& E5 {8 v% T4 f
Maker/Model -
- k3 @! z9 W% YSerial (VIN) # -
4 a1 i4 }, O4 l* ?( n' N+ l- wPlate Number:7 o- E9 F; V2 s$ |6 k5 |
Driver Name: (called driver A in this document)
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0 e ]' T# D6 a- f( b# L8 lCAR B:
/ ?7 B; c5 s$ o4 G$ o4 XYear -
' j6 M& I) ], n+ m; ~9 Y: ?Maker/Model –: C: `- M( O* a* J; W
Serial (VIN) # -" ?$ g6 ?5 m( c
Plate Number:
* S/ F& M* p Y0 n6 o2 g5 V. JDriver 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.+ G. K5 @7 w2 z$ f/ J
. z" |8 p4 ^8 d; B O6 {0 O2 IThe driver B has paid5 Z. L# S) ?( `& m, c
1. Bumper repair: $
* i* O3 r% ?+ v" @ B `2. Other Compensation: $/ i' f3 _, g9 D7 `7 Y+ J
- ?& p- r3 K) ?8 D u f( ldriver 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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Signature Date:
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( s& m5 u& G! m) V" ^+ tDriver B:
! [0 T( z& d+ R! j7 ^) ? l! |0 A
Signature Date:
: S6 Q7 i% G0 x8 {( m3 B- o# i4 S4 [) ?7 n2 F! Z
3 b0 T+ v: d _7 }" ?( N1 gWitness:1 D5 y8 `8 u0 B- G- z
7 n) N8 U( n, f3 W3 CSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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