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这里有一份
自己酌情改改就可以了。' p- u9 W3 L& ^ t, n
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Settlement Disclosure
! s* p% K3 a- O' [7 S; f0 S$ aFinal Settlement, l' q% y. Q# Q, h9 |2 u* l( c2 @5 s1 v
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CAR A:0 C- ^- P! V+ s' t
Year - z+ }- A! k) ?2 g; D& A% b# M
Maker/Model -
+ S5 c. Q0 M5 _& e1 Y3 ^3 TSerial (VIN) # -; T# c$ m3 A$ m) y- U
Plate Number:+ P; {$ w1 s Y T, K+ ^
Driver Name: (called driver A in this document)
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% Y1 |/ w0 K, U0 ZCAR B:& t" w+ X% R' n% [9 }& R+ q" H
Year -
: f9 m& m+ @$ U! U0 c- [" rMaker/Model –
2 P, s, H6 Q% w; s! \9 |3 Z! mSerial (VIN) # -# b! s) k5 a8 L3 ]
Plate Number:2 ^2 A1 R3 D* M0 q' J6 {, S
Driver Name: (called driver B in this document); I+ Q' W/ Z3 J
b" i# r8 H( h- m( {In the afternoon of Nov. 7th, 2007, car B hit the back of car A.; N2 S# u* w$ w4 e8 ~5 k
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The driver B has paid; {% Z& E0 V4 i
1. Bumper repair: $ m4 f* t$ d2 J
2. Other Compensation: $3 S- M9 [' ^4 T) T- A
0 D; W( L4 T% @driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.2 q& J" i, g+ i6 B; L. X
3 B! K0 R% W5 R7 |( U* ZDriver A:' G8 m- S# T& n9 ?+ J$ o2 M# Q
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Signature Date:* |. @- z* b h
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. Z" R/ A. ]3 Q wDriver B:$ b7 w2 `% f, C/ W
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Signature Date:4 P" }6 V x1 }5 y8 \3 s7 j8 n/ y
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9 P! j0 C, \8 w4 e( b7 j) zWitness:
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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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