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这里有一份
自己酌情改改就可以了。
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- c7 d* F+ t- t9 d" U" i5 OSettlement Disclosure# q' d5 G; \3 n
Final Settlement3 H0 \2 }$ T( |. m H% g( M. [
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Year -- l% c8 I) J+ h) a r g
Maker/Model -
- o$ n5 W; r. b" @3 w2 wSerial (VIN) # -
8 d6 v- i9 t2 m3 Z ]2 P' rPlate Number:% m i9 y O9 R, K* y
Driver Name: (called driver A in this document)
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CAR B:& [; y$ ]/ }* \9 l
Year -
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Serial (VIN) # -
% X$ |; L' U0 y0 w- h+ t# |5 SPlate Number:
7 W! Q% ^( T' }Driver Name: (called driver B in this document)
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6 {* d( b# v1 I) {: [" iIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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3 f- _! w' O, ]8 g: F4 ]. c: iThe driver B has paid
: }5 I" p. Y0 z( I' }1 j- U1. Bumper repair: $* Q; _# s5 Y/ t- H0 y. a
2. Other Compensation: $
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( j0 @, Q3 v7 J" mdriver 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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9 A# r0 a0 D% z o9 `Driver A:) B! f4 ?" v* Q- p8 }
, f4 x$ O. o6 O6 mSignature Date:
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Driver B:
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V4 L* z& p/ B& `, J& U* NSignature Date:, g5 Z/ \! `9 P$ ?1 E) a* o
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% W5 A: h* v; EWitness:
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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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