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这里有一份
自己酌情改改就可以了。 `9 Z o, C2 d! \* s' v( c2 [
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Settlement Disclosure
! k; J5 c$ L7 n x0 B- j1 W5 zFinal Settlement8 J; \4 Z* Z2 R- f
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CAR A:; M b- q7 }: S0 {0 C
Year -
( ?5 F: `" Y# j; \Maker/Model -" u: Z; a+ [; x# F
Serial (VIN) # -
- H/ d- G, f' Y1 Z8 U, KPlate Number:
1 D$ d4 G( t/ {1 L' j+ dDriver Name: (called driver A in this document)5 I6 E/ S' d1 j$ z& K. h1 ^) ]' [
4 J d O N* e( p6 s$ s( M
CAR B:
' B, n0 q, \) u7 LYear -4 O" W: {6 {' f( x+ b3 U) C7 N1 a
Maker/Model –' \6 }* o0 b( [. A, l+ W" f
Serial (VIN) # -% ^9 T- `; `$ Z& ^
Plate Number:
2 T& ]9 R3 c. N5 t- _Driver Name: (called driver B in this document) q* }2 Q" f$ i+ @% C/ `9 p/ s4 B
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A. n4 M7 u/ p/ _! v* v
' `0 w* w% w$ q3 s& Y+ c7 NThe driver B has paid
: x& T4 d- w( G r1. Bumper repair: $ m! E4 |* u& \( t& Y8 k) @
2. Other Compensation: $5 o% M# l9 u* b' p/ y1 _5 |
" Q( ]6 W* E/ m( fdriver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.
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Driver A:
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' _( p5 k a0 _4 gSignature Date:
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4 p# b: S% Q: n0 y# _Driver B:( T& y% V4 t5 P- |
* f9 `- R7 u4 p$ l, F6 ASignature Date:
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Witness:) w, z9 n2 v- u& m0 Y/ ?
) w n5 g) Z3 l2 K. vSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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