 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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Settlement Disclosure0 c+ [; h8 C% _- P0 |6 l$ n
Final Settlement
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CAR A:
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Maker/Model -
+ X, O) B2 g+ L5 g; I' U$ M9 KSerial (VIN) # -
$ j* v8 M2 p$ m$ U* {0 o SPlate Number:
$ @( B. q& r# [0 j2 [) D2 D$ IDriver Name: (called driver A in this document)' U: ^. C7 D1 P! w
; @9 e/ ^% T4 r! A# a/ D1 dCAR B:0 I- _ ~9 P! k7 {: C8 q: S/ F) A# ]
Year -
- s1 p g3 A% i! ^5 y$ k6 i* w/ RMaker/Model –
& @2 Y1 a1 h/ mSerial (VIN) # -
4 M( a6 i) O8 y) |' F% t0 dPlate Number:
, d& J1 |, ~. d# ]2 fDriver Name: (called driver B in this document)
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c" m* P7 J. ^' a* l8 T6 x! V% EIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid! W3 Y( }( g+ T' O: I
1. Bumper repair: $
: G2 q! T% \8 g$ j7 Z2. Other Compensation: $2 j* J q, a: b {6 r$ 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.& I# y l) h$ N$ l& M
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Driver A:
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Signature Date:
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Driver B:( T5 L% T0 f5 B) w8 n5 Q
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Signature Date:
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Witness:
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0 w& V( r; v* j" ^3 ?Signature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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