 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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5 G- g: Z. ? ASettlement Disclosure
, h. ~2 r6 N* H+ U+ _* T% \Final Settlement
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CAR A:
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Maker/Model -9 I6 G, i3 s6 ]7 p9 F
Serial (VIN) # -2 e ^4 N, g8 [$ g# k* }
Plate Number:" B& s- x! n' P3 X4 a$ O
Driver Name: (called driver A in this document)
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CAR B:: }/ W# @- ]. j5 X& g4 d- m
Year -
! B/ P- a/ `1 ?) p, I) zMaker/Model –% t2 a! X2 P! Y2 z, }8 D! X
Serial (VIN) # -" T+ l8 x' w7 N: ]( x
Plate Number:! K) _# k! q9 b
Driver Name: (called driver B in this document)
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( ^( @- u2 \) J0 |5 A. ?" SIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.! j( X* {! l: m: O/ x" J6 p: m
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The driver B has paid
! k9 x2 \ `% B3 p& N1. Bumper repair: $3 L% B. w+ k1 x& N( Y9 S
2. 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.
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Driver A:9 K( l! z. t" k n/ H
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Signature Date:9 \7 g0 q' j# G9 g7 H O4 W5 j: z
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Driver B:# d( C4 |. [, U1 s& F4 K1 F; ?
/ E) M; Q- e( g! C/ e$ \0 `& KSignature Date:; I. D. `. R: F7 n
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Witness:
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狗仔卡
发表于 2008-3-11 09:16
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