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这里有一份
自己酌情改改就可以了。' V2 I# n) s- _/ C" _( m9 c2 {, S- j
6 E* z$ M1 A* i! f" e; z) {4 KSettlement Disclosure! J: H% R# P4 g) J# b- b
Final Settlement
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) b5 z- f$ R8 DCAR A:
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# U" y/ G5 V+ }Maker/Model -- r1 i' E# e# d5 }, U
Serial (VIN) # -
5 L# R, }' Z/ J9 z0 t# ~7 X D+ @Plate Number:2 m8 Z# M+ E [1 ?7 o' d a: s, d6 c
Driver Name: (called driver A in this document)
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# e1 v- M v( ^7 m& DCAR B:
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Maker/Model –3 s. m* E+ b; k8 P" S
Serial (VIN) # -
7 b' _$ Q& }* F" Q# m0 ~) F( e& ~6 YPlate Number:7 j% n9 R9 x \; }3 W' B
Driver Name: (called driver B in this document)
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1 w# }/ g5 t! R* l1 rIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.9 ~1 j5 B! }, f. y
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The driver B has paid* [$ z% i; {: P0 j- V; d8 \
1. Bumper repair: $9 y' N. o5 S, e
2. Other Compensation: $
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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.
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, \$ @6 M" G& Q; W1 X( B4 CDriver A:* V- L* p# H/ G$ ?, l
. d4 [# }" [' XSignature Date:
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Driver B:
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2 i D# z$ h3 V8 P3 zSignature Date:; I- ]2 W. y: j! Z+ O% g) z
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" k8 D5 ]/ `$ q* @: IWitness:
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$ ~5 q, D/ c6 _Signature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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