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这里有一份
自己酌情改改就可以了。2 Y6 u& Z' l" _2 | J% \) Z% ]. K9 r
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Settlement Disclosure
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; {( t* ^2 p# J( HCAR A:
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- {3 R6 b& ` u1 U1 }! bMaker/Model -7 M+ W/ R( i/ N
Serial (VIN) # -, x0 L0 n- e' K3 `6 V9 M
Plate Number:6 k8 P. } D. D
Driver Name: (called driver A in this document)
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CAR B:
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Serial (VIN) # -
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Driver Name: (called driver B in this document)
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8 F! N0 M; w3 q, @( x3 _' SIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid
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2. Other Compensation: $
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4 C4 u5 Z; P; c2 ndriver 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:/ D% @, C$ w2 u: Z1 Q
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Signature Date:
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8 i) _8 A7 H* nDriver B:( O6 h7 r/ G' e8 ~4 U
- d" M: Y+ P- _, lSignature Date:
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Witness:. K; T r$ k7 b4 i- E9 M; ~) ?
1 T* d) r! x% Q: h- F/ XSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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