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这里有一份
自己酌情改改就可以了。: p \- l% S5 @ ]$ M! g& `0 G
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Settlement Disclosure
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CAR A:9 T: E$ W5 \1 n7 f
Year -
% o9 G( g) I0 ]+ i' o4 Y; Q4 tMaker/Model -2 P) O# _2 o( H5 _' ?! j* V
Serial (VIN) # -# W7 T" L1 A' D
Plate Number:3 \* m3 W6 m8 B
Driver Name: (called driver A in this document): z' m+ W4 z' U8 b
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CAR B:
" G5 Z! j" N% y5 SYear -6 p) ?9 {, J. L8 s+ \
Maker/Model –6 V& Z% A( L/ E5 h
Serial (VIN) # -9 |) W1 A; `9 [! A
Plate Number:' i- H1 Z* h) L- t2 s4 Y
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., J0 \: e- ^: ?- U0 y4 P' ^
( i/ v. Y2 W! o/ }1 w( YThe driver B has paid1 D5 b$ A' j, w# T; v$ ?
1. Bumper repair: $7 c) g5 q: H+ x' j- Q0 R6 g+ o
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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Driver A:& L5 Y! U! ~0 A4 q6 ~
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Signature Date:7 d9 D# g" t+ S* O/ [9 C* A
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1 I8 p, t( Z7 A2 z2 _' Z' MDriver B:
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) v5 J7 V8 W7 [5 O3 V# Z+ `% xSignature Date:
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Witness:' B% P" `# l: M. @7 U! z2 X4 N
9 a5 ?$ P5 \; K/ W3 ^0 aSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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