 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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Settlement Disclosure
/ I# ~! j- @, Q1 M) }Final Settlement
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% D. R1 W4 ?+ }6 r8 Z" M: ]CAR A:
0 E/ B+ o6 h, N5 LYear -
4 ^+ ` K/ b4 H: v1 j& O9 P9 s ~* ]Maker/Model -
% Z6 P) M8 ` {7 j, bSerial (VIN) # -
. P' ~: w; O" g: YPlate Number:
" A, Z+ p4 y% p6 S; q: T: m) W( UDriver Name: (called driver A in this document)
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CAR B:* S G" p" @1 e( Y2 T- e& V: {
Year -
F% ?9 w4 _8 eMaker/Model –3 ]0 ~8 d* t I" C/ l% R
Serial (VIN) # -+ R/ n( J- E' [ Q' x4 x4 B0 G$ {! A
Plate Number:3 E; y3 G: I. l. s+ |
Driver Name: (called driver B in this document)
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* b( r3 f4 ?( s( ~4 ]In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid4 d( C9 ~/ k5 W
1. Bumper repair: $
& ~- N/ p; M- w$ W: |' I) _2. Other Compensation: $
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4 V% {. ]) b3 }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. T' P/ c1 E* j! ?4 G0 e
1 t2 C% {, f* f: d0 a/ B' m- N; M9 ^/ xDriver A:
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Signature Date:
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) N, M/ Q: [1 C9 gDriver B:
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+ O: N: ?1 q; P- z0 NSignature 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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