 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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6 T- S# D, t0 u, YSettlement Disclosure* L/ A4 o8 z: v! S9 v3 g
Final Settlement0 l+ [, D6 |+ x3 j
, r' H# K J& F/ U2 {CAR A:
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Maker/Model -
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Plate Number:0 ]& u+ R$ Z: v( d
Driver Name: (called driver A in this document)3 }# p9 D4 c9 ?4 a& G5 g
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CAR B:3 p j8 y4 \: j$ D K: n
Year -
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Serial (VIN) # -/ R a5 u, h, @( R' ^, T! [
Plate Number:- a2 t; z2 A0 P/ W1 B
Driver Name: (called driver B in this document). R! C2 A k0 T; A4 {
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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3 o D5 b! R: HThe driver B has paid
. a6 X: e- W* y8 w! ?) a" r1. Bumper repair: $
3 z' s7 p0 ?: ~+ E+ g# g3 W) ]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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Driver A:2 Y% M+ {9 c v3 J* o
. C+ Q6 U. @: f; mSignature Date:9 |0 u4 k* R; @2 i0 u! }& E# c
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Driver B:6 {% Y# P; b5 C* Q+ |; X
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Signature Date:
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Witness:
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9 ]0 }2 h! f* C; l+ l2 b! u# }/ R1 rSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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