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这里有一份
自己酌情改改就可以了。: e- i% o# y+ X. O( L
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Settlement Disclosure
4 F: p6 s% T* a. C% y0 tFinal Settlement
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( y) }% Y* T8 k1 |$ BCAR A:
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Maker/Model -
. `7 p7 K, M1 F8 r, e, XSerial (VIN) # -
4 ?7 q$ `! i$ L. f/ W) T: z) dPlate Number:; V( o D! |: Y5 A. Z
Driver Name: (called driver A in this document)
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CAR B:
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Maker/Model –6 F. A0 Q8 N7 }& f9 b$ A) V
Serial (VIN) # -4 \) _3 `' u. n( J9 `
Plate Number:8 {% ]9 K- f; x- m
Driver Name: (called driver B in this document)) q* \( \0 Z. e, M2 ~
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.* Q2 `* Y9 Z+ a. k
/ W8 o$ } k6 ~/ A4 r g; X$ NThe driver B has paid
$ r( s" ?& e# q- X/ y1. Bumper repair: $
5 O$ O& B0 R4 q* x+ x2. 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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/ R0 M' S- c' X( ?6 yDriver A:
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Signature Date:! A; |- B/ d+ G2 ?6 A0 g
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Driver B:
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! ]. J5 e0 P$ y9 ESignature Date:
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4 v. ]+ H& h r# r: A6 kWitness:
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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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