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这里有一份
自己酌情改改就可以了。
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Settlement Disclosure3 j- {: T1 j7 z& K4 U/ q
Final Settlement
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9 n) B5 }& Q! o9 n& W iCAR A:; E3 Y8 I7 j7 u9 f' U8 ]9 E
Year -
* R# E B: q, B& MMaker/Model -
2 q. r% r" N" s/ Y4 k- `Serial (VIN) # -
( l8 `7 T) t- Z* G% N8 SPlate Number:9 v. y5 G$ J5 F9 D7 M8 H
Driver Name: (called driver A in this document)9 v; d- H' S) Y; G, i |
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Year -
1 ~- E9 j4 j$ HMaker/Model –
6 [; ?% I+ J7 K* a0 r8 X6 M" zSerial (VIN) # -
2 r0 I' @9 g7 |# _2 jPlate Number:9 F+ D$ ?0 U6 x. s- q) g# U
Driver Name: (called driver B in this document)+ c- ]% n5 O2 E
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.' q) I9 L' P" w2 [
$ p1 d T3 m- z% W7 RThe driver B has paid
# x, K* T5 P. O2 M1. Bumper repair: $
# ]- ^# [3 c$ I8 I1 A2. 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.* h7 X [% ?+ k$ r N: A
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Driver A:
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Driver B:
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. Z6 c j0 J1 D/ JSignature Date:0 N' _5 ?4 u8 X' F _7 D5 S
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Witness:
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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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