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这里有一份
自己酌情改改就可以了。" @; D( R U! ]7 B, f7 t* a% E
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Settlement Disclosure
" N- J3 Z! W9 J' \# eFinal Settlement
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0 l. @, H* Q# mCAR A:
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Serial (VIN) # -
0 D0 x y6 ]0 X* {" v+ c4 t9 xPlate Number:/ g [( ]! H+ \5 K; B
Driver Name: (called driver A in this document)6 X$ a9 l# ]! Q" n/ k
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CAR B:& a. P z& O5 ~
Year -, `: H4 ?7 t' D7 `& U) p
Maker/Model –1 _$ d+ g- Y+ a6 ~" t$ v+ S" H
Serial (VIN) # -
/ I5 H' H* L. hPlate Number:
, B) y2 k7 \3 A0 pDriver Name: (called driver B in this document)
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: Z% `$ d2 e: SIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid
, p: p2 k( D2 k- V3 a1. Bumper repair: $
6 v0 h, I8 r) d" k3 P/ O0 I! p) @" J2. 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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, C1 G3 W7 ]7 GDriver A: u5 Z8 R( A) L: V0 v5 x
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Signature Date:$ ^2 p N' Z8 P: I* [* ]9 \& d
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Driver B:
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Signature Date:; S1 ^0 \, O+ f$ m$ ~
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Witness:
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( b" X8 j4 {4 I6 M) B1 BSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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