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这里有一份
自己酌情改改就可以了。( }) D0 ^) t7 l6 _
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Settlement Disclosure
6 _' `' l, [* ~( }Final Settlement
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7 Q% `1 ]: S l' d, w% TCAR A:+ @1 d Z3 k8 L& o: r J/ v5 O
Year -# C+ @! v8 \1 P/ k* x# P
Maker/Model -
! h5 G/ x5 V7 n: j2 ZSerial (VIN) # -0 ~3 [* w: a. }6 k' H9 |* S Q
Plate Number:
* X7 ^7 e! }) ?( r! ?Driver Name: (called driver A in this document)1 `( Q. ~, g! i2 u& b8 J% N& w0 b8 l
6 U4 `, S+ P8 i' M5 ]CAR B:; Q' }9 |/ T5 P9 E8 I" S
Year -
- m, Y/ {& e$ n. Z# N* Q, pMaker/Model –
1 g h2 V, J2 L! h1 N# l' M% s0 ASerial (VIN) # -
8 |/ v" u0 @& ^2 O7 b0 \Plate Number:
+ c1 Z6 F' I' w1 ZDriver Name: (called driver B in this document)
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3 t, p S; h+ n. rIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.# M: L# Y9 q" m! ~6 o, H; w2 ]
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The driver B has paid
! I) D* [9 c# C% r1. Bumper repair: $
" C3 P& z$ d" C% c& h- e0 [+ B$ k2. 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.2 Z- O5 ~* g' V8 U- y
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Driver A:, g9 r$ V* N; `' c( g3 a$ S
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Signature Date:
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Driver B:: n* d/ Z( y2 q- q5 Z8 T
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Signature Date:
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Witness:. z& }8 v! h0 [
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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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