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这里有一份
自己酌情改改就可以了。
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& ?: T3 q9 f$ `9 R, s7 ~$ i6 v) zSettlement Disclosure
: X5 j- z3 P. g$ sFinal Settlement
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CAR A:
g X- _6 k/ Y. w3 k! gYear -
2 N* u4 K7 {3 S2 j0 y" x+ Q; ZMaker/Model -
. N, O0 g6 l) A7 gSerial (VIN) # -
) m. Z0 |, L GPlate Number:
% @9 B2 S# x! |; ?! W9 B2 n4 U UDriver Name: (called driver A in this document)) g4 A7 |: Z, F' {5 S$ j, U3 f# `6 Y
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CAR B:' G$ W8 V6 A* _# D4 L5 e
Year -
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Serial (VIN) # -/ z5 Y* c; f7 f; W9 p
Plate Number:
4 M6 p: @. f( K x! c) RDriver Name: (called driver B in this document)$ w% H. \$ f2 {: ^. X
/ a2 f- i0 D- [3 B, W1 }, m/ IIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.7 K5 |) G, T% N- x0 h
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The driver B has paid, j" B3 n6 }& S+ O; D1 m u* {
1. Bumper repair: $
! a* l s+ M6 h2. Other Compensation: $; O! r: }1 D6 ?6 w# |* I! A
1 S- P8 r8 _0 V# Hdriver 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.2 L5 x' G- Q: K6 F2 k) s
! r5 T8 d! T* EDriver A:
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2 H4 }5 ~+ Q* L X# aSignature Date:
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" M: m7 l* {! ?4 G8 D: LDriver B:
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9 U: D! z* }6 s1 g+ DSignature Date:; S, Y# l: M- {0 E& _
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Witness:
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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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