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这里有一份
自己酌情改改就可以了。
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V5 v! C- Y+ ^2 _% P$ i5 [2 Z5 eSettlement Disclosure* f! }& W! o+ ^; ^# s
Final Settlement; b' X6 W4 c# o. T+ D9 y% f n! q
: n* @! X- w' H* p) f8 @! U+ C7 ACAR A:
+ S; \1 [, F7 Q N$ r, k$ ^9 JYear -
$ O+ Y8 q. ^8 R0 O2 U2 ZMaker/Model -
4 S6 l7 D+ q5 [7 @Serial (VIN) # -
" O, R( D: C. ~6 PPlate Number:. ]1 ]1 Y. Z0 e* S5 f: }1 s5 r
Driver Name: (called driver A in this document)
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CAR B:* j3 V k# ]. B, W
Year -6 j8 X d y7 D* j+ Z1 V" i- J
Maker/Model –$ b/ H. W8 `- |9 f8 D0 w
Serial (VIN) # -
9 @% R& a8 o, X# x- x& UPlate Number:, I! L# u7 O) j9 x% G V
Driver Name: (called driver B in this document)1 U# j/ q; I4 t
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A./ N5 W0 K% a4 ?- C7 ?; z- N
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The driver B has paid
! v4 R; `! e1 ^2 l1. Bumper repair: $1 Q) ]4 [5 `5 e/ a( u! |
2. Other Compensation: $ h' _ H& h0 g
8 `0 n9 g- [( R% X, @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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! O+ K6 m" C9 h8 w2 m7 N6 rDriver A:
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7 ?6 s+ @! M( a3 j% ~2 V7 c! U6 uSignature Date:
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Driver B:7 [3 @ T' t! k, q* B+ ?
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Signature Date:! C( z) \5 B; B9 D" J- N+ ]
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$ R( r& B Z0 b3 u; S) D: dWitness:$ @ Q* Q2 K8 q& g1 t9 G; O5 f
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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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