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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. _( L5 u! m2 R( \7 k& \) _
Final Settlement, d4 E9 }0 y8 q6 E
$ y3 i, p# R4 Y* K5 [CAR A:, N- E c% C4 U4 E4 h
Year -
* m$ }6 `1 ?+ c! R( L* HMaker/Model -
$ n* a# L h; ]/ j, H( M& @Serial (VIN) # -
( z+ b& K* z1 A* n% W: CPlate Number:: k7 l8 i# G: b- j3 ` L9 w
Driver Name: (called driver A in this document)' m" d/ H/ y) e0 W' h
) v2 o" q% |9 `: X8 a" ~CAR B:! P: k" [3 R0 `
Year -0 Y N; u% h# o( H( @* l
Maker/Model –
1 Q g5 c ^9 x2 f6 qSerial (VIN) # -
/ |! }3 X* ~, ]9 @' P/ QPlate Number:" }4 [% D2 D8 Z& f+ ~
Driver Name: (called driver B in this document), p8 Y2 c8 F8 ~
2 B: N% X) k: i4 I! p0 g! g
In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid
6 q @! k+ Q* Q5 K1. Bumper repair: $0 D9 f4 r7 g4 Y- }* g
2. Other Compensation: $5 P4 s* s& q) ]% |2 Y; ]" a& A
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driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.. Q/ Z* f, r3 k+ K7 p
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Driver A:% l: o: T6 S3 p, R4 O4 j) h3 e
. @- e% Z) p& K: q. gSignature Date:. d- Z4 w* x' A8 u( u/ A
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Driver B:- E0 m3 |8 C' }% k7 |
. {: B: t: Y% ]( j) dSignature Date:
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Witness:+ H/ [* B! z' _7 y' s% F) p
6 {, [' H$ D* K2 J3 E& F$ B" FSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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