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这里有一份
自己酌情改改就可以了。" z$ y7 f5 C9 l2 ]: n. `4 k6 _2 s
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Settlement Disclosure
( q0 @8 L; z* v3 j" A' N5 x1 ^% IFinal Settlement
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" `! V& r# t3 N/ g7 t4 B s1 ]) TCAR A:
; ]% D) w. {( [Year -! c: j( E; B+ u% e) R& B; D
Maker/Model -. `8 f7 s: O; O* s; S" U
Serial (VIN) # -: G' z; m* _, Y
Plate Number:. |0 y7 Q: X8 u- B# Y
Driver Name: (called driver A in this document)# x9 W7 i# u: E# S1 D
6 C/ u% ]7 n$ M3 SCAR B:
# B4 U! ^$ \3 ~% {1 gYear -8 n/ T; N0 S6 P6 t: o' l9 M9 `
Maker/Model –% z. S4 I% t* F" t3 S
Serial (VIN) # -
" w5 z2 O T8 ?* T; S" lPlate Number:
m$ R, {1 {# y2 R, iDriver Name: (called driver B in this document)$ }7 G' D$ a3 I8 Y9 y( M
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.5 D$ j! u' F5 O% H% V9 y
: y0 R5 p* h9 ^7 D- o0 xThe driver B has paid! Y: @5 R+ t h. W' Y$ u% `! C
1. Bumper repair: $; { f+ A! T8 G1 X" p
2. Other Compensation: $
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: t. }) l, v. n2 O5 K% ydriver 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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Driver A:
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Signature Date:3 h9 w! ]. ?* }' ]. f& @
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Driver B: _0 ]' h0 k/ U% j
+ R2 o' E8 ^1 h( \/ u- n4 C2 @Signature Date:4 ^: E, }; X. p5 k- ?/ t9 x/ V8 ]
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6 i$ c: R. f+ n8 ^1 eWitness:/ q/ X% r) G5 ~$ W- U5 d: ]
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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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