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这里有一份
自己酌情改改就可以了。2 D0 ^3 @9 o! q) ~1 ^
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Settlement Disclosure; R' O/ I, _% N4 X/ ~$ f
Final Settlement( p/ z3 P3 h9 ~; x% f0 z8 d
3 Q9 ?6 ~+ C2 u$ M+ ~ SCAR A:
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Maker/Model -! x8 E( D3 S( q
Serial (VIN) # -
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, o% k6 ~" f$ y$ e- hDriver Name: (called driver A in this document)
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CAR B:1 m3 R2 q( k" w; p, o
Year -
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9 c1 f7 I: T l7 b' [+ Q% ^3 CSerial (VIN) # -3 p9 q" n, h% Y- |) a
Plate Number:1 p6 C! i. v. p1 \' I0 x: D- g
Driver Name: (called driver B in this document)
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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1 w& M- L# E0 d: HThe driver B has paid( f" o. Z- v$ X4 I
1. Bumper repair: $$ m3 R, U: I* N% {: A \- K( a
2. Other Compensation: $ t- F5 ~* l& m7 p+ T
/ x0 g3 M$ o& [7 Zdriver 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:1 X5 v% s' m7 z
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Signature Date:
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Driver B:1 d$ Q: Q" T: @7 i& k) c7 r
+ \/ D5 A+ I) Z( e) j& oSignature Date:
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Witness:: I3 `5 ^# H( F" c3 W- ]4 A# h2 B
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Signature Date: |
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发表于 2008-3-11 09:16
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