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这里有一份
自己酌情改改就可以了。
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( p, E" t8 O0 @: w3 kSettlement Disclosure
6 }; o; e1 _. Q3 H% _! ZFinal Settlement
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- d/ D+ m5 I% Z* dCAR A:0 ^4 N- ]1 S( u) U
Year -
3 ~! F; Z5 L* L! H* TMaker/Model -5 `0 I5 [: i; y& v- N" a4 u1 u0 [
Serial (VIN) # -
1 a" N; A* l- A q) L0 |) hPlate Number:! N { u: \% V! k* b
Driver Name: (called driver A in this document)! c9 z4 y* O# J X( U
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CAR B:
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Maker/Model –) D* I; s* L3 w, J/ v$ `* H
Serial (VIN) # -
# e) {$ s5 m1 F1 M. ]2 @5 XPlate Number:0 y) Q. M0 f Y7 O+ b) O
Driver Name: (called driver B in this document)
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* U# A/ S& g0 @9 c3 l$ u, h9 WIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.8 s& q% G" S9 u
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The driver B has paid6 s: M7 M8 U( @% ]- Q
1. Bumper repair: $
- f9 p* @1 W, m: W% |) x1 Q3 y2. Other Compensation: $4 t9 K- w+ x0 r1 P& u7 X) P
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driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.
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Driver A:7 G# e/ t. ]- m; n; T
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Signature Date:
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7 J0 W+ }6 C7 T6 h2 fDriver B:
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, E9 F% o0 ~+ u q& W4 XSignature Date:8 P1 ^9 q" c# ?
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5 f# X1 m0 I" d d, gWitness:0 c4 ?5 o$ L" X2 m$ I+ M
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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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