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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
' V# k% H: ^' B( @' ~9 n% l) i: KFinal Settlement. K% A8 r$ }% P" K$ J7 `0 G
1 }! g+ E5 I3 a1 v- }. K9 A; A3 cCAR A:
" N1 Y8 S$ n" f& R. Q, iYear -0 X* G4 u6 U) O4 E
Maker/Model -; u% ]) B% \* \
Serial (VIN) # -- U9 ~6 M- d% U! y- V2 q% s
Plate Number:
# s) [7 d2 \- w1 C6 V5 G; P' iDriver Name: (called driver A in this document)
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' k) [8 x7 O. M7 fCAR B:
2 d0 ?$ B2 m9 d# w+ {Year -0 r3 B3 \8 l4 s2 j
Maker/Model –3 B$ J# e$ k: G T2 J! r: Z
Serial (VIN) # -
# r; r1 p6 x0 P$ FPlate Number:8 _; t7 E4 {6 j0 |: `8 W% A6 V
Driver Name: (called driver B in this document)2 ]0 ~! B& w' D2 o i
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.5 U3 U! i9 i% O* K: p5 \1 l: c
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The driver B has paid
3 o( u( Y3 {6 `+ U" O1 L4 D1. Bumper repair: $3 Y" g. [9 k5 p
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." \* h4 P. } L
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Driver A:
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Signature Date:( {8 a, S% F9 Q# @
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, o0 p" i3 O5 ~4 c* |3 R" RDriver B:. b2 o8 u5 f4 X: n/ y9 ]
& L. X, E% ^1 M6 w6 f6 _Signature Date:# h$ b, y) J) g* p/ q. }
2 ]4 ]- h6 G: y- ]+ ^
3 t c- S, _( O1 z3 i! fWitness:
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5 |+ d, }7 K! K! z. V+ zSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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