 鲜花( 3)  鸡蛋( 0)
|
这里有一份
自己酌情改改就可以了。; K/ R. A4 s! `; |5 e; y
, p U2 P/ w/ m% z, ^# ISettlement Disclosure
# o @0 P' @0 k \8 J# }( n( Z6 BFinal Settlement
6 [" }, x9 l2 w& `8 Z, Z
$ j J2 M6 L2 r; F! E6 J) I# eCAR A:
' ~; n; O/ X; N$ UYear -% ]7 g3 [( M0 O& A) i
Maker/Model -
?- ?; @) M% e) i V% U' ASerial (VIN) # -
1 G1 @; ^* o6 yPlate Number:# N, h0 F" i6 }, x# ^3 g/ l! y7 Z8 m
Driver Name: (called driver A in this document)1 d6 u# Q# t& @7 [3 c0 O$ e
; F/ w" }% v0 B; A2 o1 Y3 b
CAR B:9 L; M2 k; q8 Q" g$ T% g0 B2 d; Y
Year -% [4 e6 G2 S2 g {% S# o& h# W
Maker/Model –* ~8 }! }) c* J; x
Serial (VIN) # -/ q: ]$ Y' _7 e( u
Plate Number:3 \# E0 Q3 ]4 V! I+ C) V! h/ B
Driver Name: (called driver B in this document)# n( m# p$ U. }# b0 T) ~
& M$ E1 H- W7 s ~- Z; e& |) R
In the afternoon of Nov. 7th, 2007, car B hit the back of car A.6 N9 m1 \3 @6 ]( f
; c0 O. g& y# a i
The driver B has paid
! X$ l) v/ J# f1. Bumper repair: $# G l4 w, o' x/ q6 L
2. Other Compensation: $
. K( d6 ?& m9 O/ d* A% {( M6 c" Y* B$ m- p0 z
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.
# T' C& s# @. P# s! P3 ]
6 X" }2 I% S2 J# c7 u$ vDriver A:
! P9 M- U4 [5 z- F+ N+ ]/ K! j3 N+ ^7 V6 d' O1 m9 S. A
Signature Date:
5 k3 F/ \+ S" e' j3 G; U5 } q7 D
0 w0 Z, I- f9 S5 q5 F8 {, q4 m* x z2 f
Driver B:
; ?7 R r% A* l5 B* A- P- b# D, b6 e% T( a* a( d b7 {7 O
Signature Date:
0 W ^, x3 q6 l, u, i
6 ~+ H" u5 x' w) N% t3 T# y0 H& [$ G* }4 V' B/ N" e9 m3 s T6 ]+ D
Witness:7 {5 O; F0 s; F" o
, R f8 ?: d; ~7 i1 }
Signature Date: |
|
狗仔卡
发表于 2008-3-11 09:16
提升卡
置顶卡
沉默卡
喧嚣卡
变色卡
显身卡
楼主
