 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 Disclosure
( K4 g, o9 x- O* @( g5 cFinal Settlement6 J) ^. |. R2 A1 C! C* H" }& ^( m
/ Q! F; A9 m; y, r: {: |+ fCAR A:
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Maker/Model -
2 x$ u4 I( k6 H2 gSerial (VIN) # -
3 L' J! B4 C! J: L x4 YPlate Number:7 p/ P8 r8 \9 N5 v9 G, R" n
Driver Name: (called driver A in this document)
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CAR B:* e. O+ d2 A! p& p7 Z$ }
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Maker/Model –
# H) L6 A* Z; W# U" ~" {Serial (VIN) # -
% {; w8 Z* p1 }* uPlate Number:
6 p: H( g" H) z7 m. s6 x- ^2 B5 NDriver Name: (called driver B in this document)
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* F7 c( G. z* d0 I8 E7 NIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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2 B }- P9 G+ {( XThe driver B has paid' H l4 o8 L4 O. ^3 f d9 g
1. Bumper repair: $
3 L& r) b) U% c3 X/ v3 k2. Other Compensation: $& S; F9 e ?+ U- E7 p
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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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; f) ?' K4 z# _* NDriver A:2 g) Y, r2 \/ o
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Signature Date:
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2 s, d* A! a& n* s+ C: gDriver B:! }9 H% t9 x" Q: O6 _
1 \6 p% t- b- M& PSignature Date:; h' ?8 J5 B3 @: A( T P) {
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Witness:
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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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