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这里有一份
自己酌情改改就可以了。2 {7 J) I. ~) K7 m7 q
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Settlement Disclosure( U! `1 e* V0 J% V$ l/ H+ n& A" W. \
Final Settlement) l0 W# a' ^* ]8 }8 h7 F/ w
& ]. U: w1 ]; ]7 T. f8 gCAR A:: R4 B/ Q1 b8 j4 I! }
Year -4 C! @$ T% @0 |6 J; [* z
Maker/Model -# |7 |( }9 {" h1 Q* o1 s% c& C
Serial (VIN) # -5 ?1 I; ~0 _. { }1 l" z
Plate Number:' {' V# c; [) Y3 l9 G& ]1 u; s
Driver Name: (called driver A in this document)6 I/ T$ B: A0 ^ D5 v2 @- Q. W
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CAR B:( y: \$ C5 S) s7 R9 i; T
Year -
$ q7 n: \) C: s4 q; EMaker/Model –/ j- j4 [: u$ r- `9 t+ u- |8 r" }
Serial (VIN) # -
( }* a, H+ h( a7 }& i5 I" U& SPlate Number:
. t7 _% e; b6 R, s: N$ H. H4 M uDriver Name: (called driver B in this document)8 W. H! x. J1 a* @! S
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.' I }" u8 E7 S# M- u' d8 I. p" f
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The driver B has paid
) q* d- j8 X. E( J1. Bumper repair: $
7 j+ t! ?; S+ `. H7 @$ W2. Other Compensation: $
8 x! h4 V& J. `
' ]% [5 E+ S2 K- U2 M/ [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.! o' T6 S, ^) s, w( n7 l
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Driver A:9 p) A6 l X# P( \
, H9 A4 m+ h* J3 HSignature Date:
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Driver B:' E/ f+ a( D4 j' n
: I, H `/ o. ~5 h: x# \Signature Date: z' x, X n0 |4 K
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, j: D* m" C" `; s5 FWitness:
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7 i; b" w1 w) E* K, e' o( cSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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