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这里有一份
自己酌情改改就可以了。
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4 H* K9 \( ^ e) _+ `Settlement Disclosure3 g& x+ A& J( `: g) c
Final Settlement; i+ O. s7 I% m9 C) B) {6 z0 l6 k
; R4 w# ^$ E8 r, eCAR A:
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$ Y z) C% p2 J) D: a% ^Maker/Model - P8 x0 O0 f' w9 n/ n$ N- n
Serial (VIN) # -
/ l c: [& B- F ^- IPlate Number:% V0 Y7 S( J: i6 Q
Driver Name: (called driver A in this document)" H( o# J9 H) g. Y1 i
. E+ V) z5 ?# K8 Z1 n3 E% k( fCAR B:
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$ h/ I# G. e+ M. B' @- mMaker/Model – H" O9 a! u' k1 Y2 P: M
Serial (VIN) # -+ {+ f8 O* U0 Q7 E# j" I' v
Plate Number:
; @* B. r% A6 fDriver 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.
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The driver B has paid7 a9 o9 {, M4 C/ W/ U% v
1. Bumper repair: $
) e; e7 G4 ~! g. ?* z2. Other Compensation: $" {& G! p+ R+ Y# U
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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.* d* ]. j4 a" b6 b8 ~
0 Z4 j: G7 V7 f, ~! [9 KDriver A:, y0 X |3 O) d
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Signature Date:
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Driver B:1 R5 F+ P8 A: d9 o
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Signature Date:
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Witness:
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# m" D( {1 l. h# W( J JSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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