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这里有一份
自己酌情改改就可以了。# c# ^3 E1 v6 d, q& X8 A) k8 a
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Settlement Disclosure$ P# Z/ j7 p, o4 F
Final Settlement9 R5 R( h' L7 y- L7 }
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CAR A:8 v: I5 u6 d/ C# u( ?' o
Year -6 n* F) ]2 F6 F& j# y
Maker/Model -9 q% W+ r- x8 f) z$ B
Serial (VIN) # -+ I' z& y6 \) f# i: ~4 b/ ?
Plate Number:
! U, k% `$ O: r3 IDriver Name: (called driver A in this document)2 W2 a" D1 I1 _* V5 [$ n5 V0 G
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CAR B:
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Maker/Model –6 H' i) k0 \; | l
Serial (VIN) # -
2 f5 b& M: c; qPlate Number:
% B4 @3 i6 U, e5 K" F1 fDriver Name: (called driver B in this document)5 H. ?8 P) {1 q# [% w* ]) t
; h! T1 z) g- d* fIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid. H; ?: K9 d+ ?" U" f- Y; T( m! Z
1. Bumper repair: $
1 F1 S+ V0 T- q& c# K; T r2. Other Compensation: $6 e z- F* Q4 f6 Y& |5 A+ g4 z
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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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! r8 z. q6 O, x- nSignature Date:
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Driver B:
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" E+ H, E# h; b1 E; c) J( ~. pSignature Date:
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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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