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这里有一份
自己酌情改改就可以了。1 t% ^7 i: k l$ h9 } s4 ]
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Settlement Disclosure
4 S Q+ O; |* G6 MFinal Settlement- ^5 ]( M9 p, l) a# Z. L
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CAR A:: S+ {7 Z- i" F7 P& U$ c9 e3 W
Year -
& [- R8 Z5 |' }" z. h9 SMaker/Model - C b% t$ {& x8 A$ w5 d2 c
Serial (VIN) # -6 K0 @. Y! @: R" i( d
Plate Number:- ?: z9 V) b8 ^! S2 I
Driver Name: (called driver A in this document)' Y" Q$ C5 i6 V0 M. \" l f
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CAR B:* F; j' E4 `8 I- d3 T1 m
Year -
( A* X! k, x& t& `Maker/Model –* l7 Y, |) K6 ~ l3 N
Serial (VIN) # -/ [+ `: v, K2 ?4 P$ i
Plate Number:
, z% Z6 v% M7 E! lDriver Name: (called driver B in this document)
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% o5 H7 V/ j6 j, {# T- ZIn the afternoon of Nov. 7th, 2007, car B hit the back of car A./ V8 q% `" u3 x2 e. P
+ i' w+ a' S7 K2 o+ h1 s, r: y" dThe driver B has paid# [$ T/ g' M# c# r+ B% X
1. Bumper repair: $
) D" l6 G+ N4 V/ A2 m2. Other Compensation: $9 M( ?% x: s2 u( X" n) a1 T$ U
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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.' _$ p& x" G# Z
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Driver A:
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Signature Date:% b; C, j4 z2 j9 j) h6 m0 R( X; V
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Driver B:
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2 p/ j9 q0 M+ Z- F& ?8 S; USignature Date:
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Witness:
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& ?" y( h5 M5 \4 r, s& W& F3 n+ a MSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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