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这里有一份
自己酌情改改就可以了。8 @0 s+ q% y2 [) n
& w: w$ K& `) b) x( ]$ @Settlement Disclosure
1 j4 b, m( b" g8 O! IFinal Settlement
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/ Y, x1 `2 k# f8 a) tCAR A:
! I- K4 R+ |3 AYear -
9 m+ N& D/ {; S/ ^Maker/Model -2 D/ j5 ^) ?1 v! c" Z
Serial (VIN) # -( D( W. A: F7 \3 Q
Plate Number:
. g& p% L! c; ?" h3 `: H! F* {2 KDriver Name: (called driver A in this document)/ u% M5 N% A0 U2 b4 a8 V
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CAR B:
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Maker/Model –5 B& a4 L5 e5 V/ Y) D4 K& ?7 P
Serial (VIN) # -
j3 [3 G2 r' \: J6 I% z( ^Plate Number:
2 p3 p# U( J& g, Y+ W( J; q% ]Driver Name: (called driver B in this document)
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+ H; K6 S* t. A6 zIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.0 O$ k1 ~! }5 i
: y( b! _. i1 C9 S, TThe driver B has paid5 O( \) G9 o% Z6 b# B
1. Bumper repair: $
. b* g, B% v) I$ H* J- _2. Other Compensation: $' z0 A! h1 ?7 m/ s' k3 @- q+ T
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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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3 M Y+ }% X5 |) i2 k4 PDriver A:
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Signature Date:% {% i+ b3 B' E
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- g1 F2 L) `% t4 T. k" ZDriver B:. v' T' P' Z% G& x) G9 w9 M
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Signature Date:
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Witness:- q l7 P4 r, A8 }: n& D
. x) x3 i k6 N! R7 E: @. p5 x JSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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