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这里有一份
自己酌情改改就可以了。4 D% P$ r" V+ n/ u# H0 a) s! o
" @2 x5 U. g! XSettlement Disclosure
- e1 y: V0 @6 Q& y- rFinal Settlement
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CAR A:% C, m4 S( j7 C' i) H& [2 p$ Q
Year -
! U9 Y/ ] T' t6 Q( H6 PMaker/Model -0 c( q' s2 d8 ~0 n0 ~
Serial (VIN) # -( H% G: _; D9 O
Plate Number:
# o- E8 X* Z0 G; k# S+ ^Driver Name: (called driver A in this document)( b. ?5 D' P' v7 s, v# W' r' ?
d7 m" o; m! M) m
CAR B:
/ q4 K9 N; f2 r' Q' C2 NYear -
! @0 h. h; l8 L: S ~ f- _Maker/Model –$ w" e, x N. u5 U8 ]3 t
Serial (VIN) # -$ f8 h9 @% ^* c4 r4 L1 [
Plate Number:9 q6 C) M) h! G: z4 s7 _% K
Driver Name: (called driver B in this document)
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) v8 f% v1 E/ l8 b' U% NIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.( ^* N0 w) q1 n% d( `5 `
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The driver B has paid
; x4 R% ~! k7 _6 ~ g4 a" w( e1. Bumper repair: $. @; c/ i5 _0 g$ J; E/ E! k: X- t( P
2. Other Compensation: $, L) _" o+ ^! P
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driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.1 f0 x/ t, a L7 ` F
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Driver A:
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' h0 e1 O1 `% r5 _2 k# RSignature Date:! N+ U. ~% f {7 f
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Driver B:
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: t, {1 v1 A+ g1 Z7 S RSignature Date:
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Witness:4 Q+ n' u! P, E4 L: @6 Q
5 z7 \# |8 g) A2 c+ m6 d/ i$ GSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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