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这里有一份
自己酌情改改就可以了。" x! k3 M2 H! d" ^" J& D
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Settlement Disclosure
w, U" H" z' `7 e0 d mFinal Settlement
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CAR A:
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Maker/Model -
: Z- L7 d, Z. X! J/ J* x. lSerial (VIN) # -. \- s; @: u' H/ F0 o5 [+ w
Plate Number:) @: b7 l# o' W9 W, O. j6 C: \# j
Driver Name: (called driver A in this document)
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CAR B:- p# g& F# O$ a8 F8 W" a
Year -+ b9 D0 G( @5 q& m$ R. y
Maker/Model –0 g% @) N4 d; X5 d
Serial (VIN) # -
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Driver Name: (called driver B in this document)9 y2 ?3 V, Q1 S U$ a) ?$ B% j
0 _2 o3 [9 c/ |In the afternoon of Nov. 7th, 2007, car B hit the back of car A.7 E9 Z( l! Z- t5 W5 R
# T1 F& k# x6 x6 _4 Y- rThe driver B has paid
: g, a7 Z! t6 `1. Bumper repair: $
, ~ Y1 v# ]; W/ |) O' r! v8 U3 `+ n2. Other Compensation: $
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% W6 }( ^- N' ~5 O; Fdriver 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:
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Signature Date:
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Driver B:7 M1 ~% B, s* u8 m- P
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Signature Date:% j) U5 t# x# i$ [/ m
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Witness:+ L3 o7 M1 U I
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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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