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这里有一份
自己酌情改改就可以了。$ h$ F) h: Z- m7 z0 s2 S
" B- ~% [3 R6 u! F+ C. L) sSettlement Disclosure7 m. ]0 ]) i G2 a# [, b5 c$ a
Final Settlement
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CAR A:% i$ T5 V1 H" W& e- `
Year -/ T U# s W1 L% Y( v' B: T. F# q
Maker/Model -+ Y1 r" d2 }# z; C# s2 }
Serial (VIN) # -
/ {$ O/ J( B+ c* p# L5 i0 a; kPlate Number:
7 r' h# z+ c& _6 FDriver Name: (called driver A in this document)* T: A1 y; g6 U- @/ P
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CAR B:8 W u% ~. i4 f8 ~9 }! ^1 D
Year -
1 J! a6 p; ~* L6 m; \* x7 lMaker/Model –
3 A) T) Q% _- n/ Z6 m$ ASerial (VIN) # -
! }, q* i) \7 I1 uPlate Number:
, I7 k/ C, K6 t' [! s2 Y2 L: S# Y+ q/ J6 NDriver Name: (called driver B in this document)& C" o c0 {( @+ T) @
# _. M. k! K& S3 F0 aIn the afternoon of Nov. 7th, 2007, car B hit the back of car A. v, E5 ?! T; C6 U9 l4 p4 W
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The driver B has paid
+ q$ r f! W) A6 W& }% v/ B/ _: K3 g1 h1. Bumper repair: $9 ?0 W4 q/ Q5 N9 k. Y z
2. Other Compensation: $0 N7 I8 M& y& Q* A
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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.: T8 Y4 Z! X* M0 m: S* t- S/ N7 | `
' E. J, }& T9 ?7 v# T/ p6 Z EDriver A:1 l0 |; p) w+ [' e a+ N
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Signature Date:
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Driver B:5 B" ^5 Q2 s( m8 O' F, y/ c
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Signature Date:8 M, C* ]+ k7 s
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: y3 H A" D+ ?. r+ tWitness:
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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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