 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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2 U& y* A% b5 L+ ^Settlement Disclosure4 O1 O" L) Z6 s6 Q, U( u; g, b
Final Settlement
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Year -
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Plate Number:
2 z% c, w4 q% }Driver Name: (called driver A in this document)1 r/ m. |# Y% g4 P8 q
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CAR B:
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4 G( x; i* H3 v; K/ q7 b1 EMaker/Model –6 n4 X& J* {: w/ h
Serial (VIN) # -
' p6 Y& p' ^9 a. {/ q% T% UPlate Number:
; N$ t6 j4 g: Z7 n- b' dDriver Name: (called driver B in this document)$ J; o4 O* F& A* L+ \: \
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.. j2 @; T/ P& N
& T3 N2 p8 w r, n) T! s- xThe driver B has paid
! a0 ]' f& H) z* n1. Bumper repair: $
8 b0 E' }0 B R u$ g& c2. 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.# b x; k" I6 X
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Driver A:
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Signature Date:
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Driver B:
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Signature Date:
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Witness:2 s0 l* X- ]0 G8 D- W+ E
1 c8 A: b# ^: t, a% PSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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