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这里有一份
自己酌情改改就可以了。6 R5 }# H$ p3 l& \( y q2 b3 d0 H
( U' b* r. ~9 Q' J; k# tSettlement Disclosure. s% X/ S2 x! @/ |7 M, {+ L
Final Settlement1 [$ J) V8 E5 S
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CAR A:
3 S% A, _3 P8 j$ MYear -4 U4 g x! M' L M+ G" y& a
Maker/Model -. J# l% c/ A8 f: ?
Serial (VIN) # -
0 a$ m: T$ u$ b. e$ F- LPlate Number:
/ L# _ O$ N& w/ T eDriver Name: (called driver A in this document)
. }: b1 [+ F* ?9 J; Y. G+ m/ J# m9 r5 U2 q
CAR B:! \' k$ `$ ~' `
Year -# u3 s6 k4 ^* [+ B4 V
Maker/Model –# r- n" o! l& M( x+ @
Serial (VIN) # -
% p7 V# P+ @& }4 r. Q8 a4 E# CPlate Number:! p) E8 U9 @: W h! K
Driver Name: (called driver B in this document)) B: T8 D! d6 L( ?' J& |
" o6 O3 q+ n3 U7 [% M' wIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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" S4 |3 d; x c: L/ g5 VThe driver B has paid
9 ]0 g& ]( h& [: D# D1. Bumper repair: $) L7 Y1 d9 O: a8 V0 n( h' f
2. 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.
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# `4 e9 ^6 V' m" Q8 h! A/ l& j, `7 {Driver A:
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7 _& s# h& n2 n u* w9 GSignature Date:2 d4 a; u) G2 C6 K" K* S4 i0 a
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: |; n" g$ i% PDriver B:1 ]8 k6 Q T9 S' @: j5 m
5 K3 V, T F! [/ g" dSignature Date:. a1 z% W# B5 _* I
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Witness:
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8 U5 o0 Y# J; c8 [1 e7 h! A0 \; g! xSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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