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这里有一份
自己酌情改改就可以了。. v H9 b. l& Y. [2 z
% v; h$ p1 K, U# r3 ^Settlement Disclosure+ L i0 E8 u% w- j
Final Settlement
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CAR A:
7 Z& p ?/ i" eYear -* }& k: K& b: L3 j
Maker/Model -
2 A, X7 [. |9 E' r2 T- S4 BSerial (VIN) # -( K# S3 I! J/ O/ p9 M4 |$ p
Plate Number:
3 T& }; U+ S; w+ w/ h& z E7 nDriver Name: (called driver A in this document)
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% T5 ~" F1 b6 U1 g, j$ ]CAR B:
" G+ N) [5 I! BYear -
8 I7 f) V- Z r3 N: s( F; NMaker/Model –) c8 ^" z- l: `7 s7 A
Serial (VIN) # -( i! J R6 d& p2 w9 C7 Y
Plate Number:
1 Y' m/ F H* X4 X% ?) TDriver 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.- A! P8 ^6 s; E# `9 g/ |
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The driver B has paid
9 ^0 e8 U2 e. {; E1. Bumper repair: $
M4 S* P4 e, `1 m+ V, |2. Other Compensation: $
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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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Driver A:
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Signature Date:& K$ V' P" I. D [
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Driver B:) M9 v/ ?6 R+ w" t5 I- W' n% i
8 Y$ U$ D% R; T; eSignature Date:" s, ]# Y2 H4 r% O& R) [
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0 X8 d$ P1 [' `Witness:& r( I" L" q+ ]8 g" W
& e7 g7 \) H) u% N. YSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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