 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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% W* A% E( i5 K, |. X0 n7 oSettlement Disclosure) T. E o6 ~8 ~% _6 }% n I+ ?3 g% i
Final Settlement
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CAR A:
- h4 Q3 X, `$ ?Year -0 _ I6 n' a8 C& D
Maker/Model -; {6 j/ f5 c/ s3 U- A! {# L( ^/ O
Serial (VIN) # - O9 o* I8 Z% I% Q u
Plate Number:
/ I! |( e1 Z( b. F3 bDriver Name: (called driver A in this document)0 O1 B/ y9 x$ i/ N5 { U4 D" @9 B
2 X, s3 p9 U) Y( E5 I# g1 rCAR B:
9 b: `3 p) R- w* |Year -
9 h. [4 n6 \) o% [4 z: bMaker/Model –
: ~# E& M% D, g* `& o1 NSerial (VIN) # -
' @# k# X- a2 e( h7 K- DPlate Number:
6 G! K/ f' E) ]( J: Y' uDriver Name: (called driver B in this document)
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.' U3 R; f# d% W8 |8 |
- n) `( t4 e, y: `/ w- H3 m# XThe driver B has paid8 z7 x! m2 F8 c
1. Bumper repair: $
* r. J3 i+ Y6 x, c! v2. 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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+ p. G3 Q8 n* a6 Q4 {) eDriver A:# A5 R" i4 }. b; R$ b2 `
$ N& [% ? z$ _6 _& ^Signature Date:* C9 f; @" P& V$ a
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Driver B:) S* o2 O% F" X5 R6 a
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Signature Date:
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Witness:& I7 C( D6 `1 ~. R
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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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