 鲜花( 3)  鸡蛋( 0)
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这里有一份
自己酌情改改就可以了。
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- R1 Z$ i- [, I6 U* V% q6 s9 lSettlement Disclosure% n/ v5 ?3 r5 |- c- s9 D9 \5 c
Final Settlement
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CAR A:
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Maker/Model -- M+ d2 C. s: J9 |7 M
Serial (VIN) # -% m# U* R0 u- B
Plate Number:5 ^2 [3 H4 {. G" E3 i
Driver Name: (called driver A in this document)
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CAR B:. Y/ K7 ]% M( r1 u; t
Year -; x- q9 _6 D/ }
Maker/Model –
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Plate Number:
, V. r# l" ~* y$ I2 U( e5 nDriver Name: (called driver B in this document)$ A% Q4 w" g% a2 y% i4 G. w5 ^
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.4 b+ N, ~& L! I2 Y4 w2 b
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The driver B has paid
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2. Other Compensation: $
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* S* x2 f3 _) j0 M; L! ^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:( E" `, l6 m- C' g5 p2 Z1 U
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Driver B:' k" g$ k4 E5 p7 i
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Signature Date:3 v' f B: d, o, K7 X, w( h) N
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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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