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这里有一份
自己酌情改改就可以了。9 i0 D3 T: V$ W4 A# ~! G' S( _
7 K2 W, R; i$ V5 Q) v: g6 SSettlement Disclosure+ D( a o# Z6 _5 f/ B2 m3 c
Final Settlement# X' y' A, O' w q( ]% G
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CAR A:
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# i2 y' N, ^" f: N1 u* z8 d3 X' IMaker/Model -3 t9 _7 d+ Z0 V; c/ {
Serial (VIN) # -( i1 }8 {7 A) g) @" G. P. y0 Q7 _
Plate Number:
. v7 k+ M" b& s: r* ?! mDriver Name: (called driver A in this document)2 _7 ^, p" |) f- A* Y( p2 `8 M( E" c
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CAR B:
" \3 `' B0 B+ o7 [Year -1 m \0 M5 f2 k+ _( X# U
Maker/Model –* G+ X) `# c! a" r
Serial (VIN) # -$ \; \& x2 |- n, o2 j5 {: y' P
Plate Number:
K; L* Z- R9 w. _Driver Name: (called driver B in this document) k3 K4 I/ |6 ~/ ~
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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 paid
, R$ K* U7 b1 _4 ~: a5 C1. Bumper repair: $
6 z8 ^' y& F+ G) ]2. Other Compensation: $/ |+ K3 r3 ]; W! L
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driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.
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Driver A:
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& q5 `1 C6 a3 G& V9 ^Signature Date:. i0 K- s, g/ A" Z2 h. s1 Y
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: M- P! i9 O, Z$ M- ADriver B:- H' z5 z5 Z% J
) l8 [' G- P OSignature Date:+ D% v+ p' S; Y
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Witness:0 {2 e( ]2 R$ t5 K7 T; Q7 I
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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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