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这里有一份
自己酌情改改就可以了。: c& F6 e9 A. G8 _4 X7 M
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Settlement Disclosure
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. o" A: {$ Z9 o7 w& fCAR A:
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7 {) ]+ k2 H# J! C: ]Maker/Model -
! n2 g/ ?$ a! o9 V3 @Serial (VIN) # -5 G% h- [& C M8 h- T1 _
Plate Number:
( e s- y# X: K1 ?) MDriver Name: (called driver A in this document); K: Y* e1 F# I
% r* H7 P! ~+ W' { zCAR B:9 c3 g- [; d& K2 O0 ?0 `! }8 Z0 k
Year -: F' F. Z f9 M9 W( f8 z9 x X- @3 u
Maker/Model –
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Plate Number:& D# E2 n* `! ?( ?& S
Driver Name: (called driver B in this document)
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid5 h5 }! [6 F& @. J s7 |; Y# J- d
1. Bumper repair: $
1 N3 p( d* L( ^) M+ ~) u+ ]3 @$ j2. Other Compensation: $
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* \) _+ g; ^# C* P7 ^- g* Ndriver 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:0 j! }0 G6 ]: s0 ?8 z
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Signature Date:& z5 A4 I) H7 b, ]2 m
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Driver B:9 j0 U4 D$ _. d: S: t" ~- v! Y* I+ O2 I
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Signature Date:4 ~0 | ~8 f9 Z1 E8 ^" r7 ~
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$ S6 _; b# D6 M: S2 XWitness:! v& V L/ C( ~' h; _
+ q0 `9 U9 {# I& aSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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