 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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Settlement Disclosure
5 _4 P& j# w# Z3 n' m% a9 C( I6 sFinal Settlement
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CAR A:" C4 y3 w! P) ^( G2 n
Year -
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Plate Number:: ?" _7 {# ^ t; s5 p% d
Driver Name: (called driver A in this document)
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CAR B:, M4 r: |/ G' h4 N, U
Year -5 X0 H0 e, Y0 O r
Maker/Model –
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Plate Number:- _1 m/ G$ D. c; l
Driver Name: (called driver B in this document)* T3 h' `, S, Q, R) P4 A
4 k; Y4 x3 h! T! o( F& w; [( sIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid. n+ d9 L6 d3 q% Q- m# y6 K- M0 n
1. Bumper repair: $
9 B: B: B9 f, T2. Other Compensation: $
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* b. n- Z" d q+ p/ o( ~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.3 Q# L3 q: @6 L1 _, r# B2 r) k( C
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Driver A:& |9 p" M$ H+ A" |0 Y* q% h; v
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Signature Date:
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Driver B:
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# m- P0 ~2 E/ h6 W# C' H: c# pSignature Date:
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( h" k7 u( n% f) e( N$ z9 jWitness:
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3 ]! [! _% b: {6 c" ^7 p' v% b1 kSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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