 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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Settlement Disclosure6 e9 N6 p3 l f) P7 O1 X8 L
Final Settlement9 h7 {9 r* ]# b$ B
% o' V8 z: o5 `' n) z& sCAR A:5 k n: e8 D% g& _; F" `( g
Year -5 x5 L( B+ w* z+ ^, {/ l6 }6 \( p
Maker/Model -
% G/ m( s/ z1 F, T1 `0 ASerial (VIN) # -: M* c+ e! N) D1 z$ q2 C F- d
Plate Number:' q4 Z1 P1 G3 D' X+ R+ ~& f
Driver Name: (called driver A in this document)
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CAR B:
$ k9 G" l" g' R3 t$ B, `( K; ?Year -
8 n9 ^$ u$ n% `+ aMaker/Model –
4 v7 A9 t9 s J6 W8 @' d- p/ BSerial (VIN) # -9 q# t$ M3 S% ?; V6 d
Plate Number:
8 c: A/ ^0 d1 i5 T. j$ t( f# u0 HDriver Name: (called driver B in this document). H* B6 O1 i1 p/ J# U6 b
; k7 k2 N* f8 k0 bIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid
5 C. h) X2 y1 b8 s: g1. Bumper repair: $
- f7 @8 Y6 W* k6 Z8 R2. 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.4 E/ j0 H- b" Q# ?6 i2 F5 g0 t
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Driver A:0 |+ G8 c0 _# n: S) d
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Signature Date:
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$ H$ n* V) S0 A7 tDriver B:, Q) @3 ~/ T) l4 p
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Signature Date:
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) L F: y7 \" AWitness:
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v' F& L% L, dSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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