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这里有一份
自己酌情改改就可以了。
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Settlement Disclosure7 _9 x2 s! v1 e5 C
Final Settlement
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0 t @$ V+ m% _! `: o2 j( `$ LCAR A:
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& g( v8 Y9 _1 g8 c6 ~6 _3 r" nMaker/Model -
$ E, ^6 g% m1 D& h( Q1 e7 m- VSerial (VIN) # -
8 R( x$ d3 z! \, Z8 t5 M% jPlate Number:1 S4 g8 M( U, E/ Y$ A8 o; M
Driver Name: (called driver A in this document)! r; w9 y7 @/ T8 Y4 ]
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CAR B:
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Serial (VIN) # -" p; T2 P# u/ S, L0 ^% P
Plate Number:- V* ~. {7 M* @ f
Driver Name: (called driver B in this document)
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# d2 J* ~; q1 EIn the afternoon of Nov. 7th, 2007, car B hit the back of car A./ x) i; ^4 Y: p+ t3 T
h5 T2 \7 I* U+ h j3 WThe driver B has paid2 Q5 `7 z' T9 T# j7 b; ]) x
1. Bumper repair: $) ]% l* ~3 D: ^
2. Other Compensation: $7 m9 d* B7 c& }$ O; j
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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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$ f# H1 E. v. H9 b! sDriver A:
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Signature Date:
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: Y. ]. X+ M5 \, d% i, A: E& y* gDriver B:
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Signature Date:
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w# W( J$ h# ]7 y* |1 E% V4 _! FWitness:' F2 }% D+ X6 a) r+ H" }
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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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