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这里有一份
自己酌情改改就可以了。
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) D1 w: R1 \! M3 e- xSettlement Disclosure' o6 t- }( S; h* `$ k2 _. x
Final Settlement7 m' e. A: _1 @- b8 D$ ~
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Year -# g1 N7 j+ i0 G5 @+ {' t
Maker/Model -/ o7 s! ?( O- G
Serial (VIN) # -" V! _5 r3 k- g: t) K- U6 L
Plate Number:8 |: h. H# R/ j2 B% f
Driver Name: (called driver A in this document)$ t c8 X, t) x4 P3 _7 Z" v# k: o
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CAR B:
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Maker/Model –# i2 q! g) S2 ?& v+ i. M
Serial (VIN) # -
1 i4 x- x( }7 LPlate Number:
7 q) n; i$ V9 W m5 S5 y {Driver Name: (called driver B in this document)
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$ Y- v, J5 {: l/ c" f2 l, sIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid& ^$ A! m4 l4 l j* f
1. Bumper repair: $% |4 `! X( F6 {
2. Other Compensation: $+ e, r$ L$ [2 X( K
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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.6 D2 \( y( o; D. D: H6 M) m
7 G G N% C# k0 QDriver A:4 z; Y: ^6 b( S+ o7 Y
' h! g) l A' gSignature Date:; V B) \ P8 L7 @
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) X0 {9 `+ P% a+ w: D- m" rDriver B:
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Signature Date:
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" d( l. q& [* F P/ C- HWitness:
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/ i, Y! ?8 z% l/ GSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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