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这里有一份
自己酌情改改就可以了。
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9 b1 n& O/ Q9 {0 O5 J; ~Settlement Disclosure8 g1 f! o3 _* Z; a5 R( J1 ?
Final Settlement- J8 ]" V! a# {4 \1 E. R% {) r
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' e5 Q9 a+ E$ F# kMaker/Model -
( J; r: h9 K0 B |4 \0 n6 Z) ^Serial (VIN) # -
8 r8 I- G9 n1 V% p. ^. zPlate Number:
% l0 I' ^: d+ ?, c1 N7 ]# E6 qDriver Name: (called driver A in this document)" p! G, P/ z4 H; u% l' u
) V$ w5 [( B( \+ K: r* qCAR B:
/ U' ]0 Z0 x/ k* DYear -% V6 A: S% u- ]1 ~# |
Maker/Model –
6 Y( z# g7 f/ ]6 _! k3 BSerial (VIN) # -
0 J6 g+ s1 ~# @0 vPlate Number:
" {7 ^1 h5 b/ e, lDriver Name: (called driver B in this document)
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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6 ~. c& C1 B9 l( sThe driver B has paid
; M! E6 q; b% U; I; j9 J9 i! l1. Bumper repair: $
7 ]6 X/ E4 |( I5 ]2. Other Compensation: $
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8 u" y" P' g! U1 A/ w/ |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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) a9 R! U; q* M+ T# l- A5 [) ]Driver A:4 E# s6 |' M; v8 d$ w; y
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Signature Date:+ S1 @9 ?2 v. }( A- W
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Driver B:
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Signature Date:4 R( o; Y0 V" V: _- K
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7 ~( l& E# G4 r, v7 @/ F5 `Witness:
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) k/ g* c6 n3 W, V# jSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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