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这里有一份
自己酌情改改就可以了。8 [7 C2 k# @ C0 f
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Settlement Disclosure% l- S+ h! d* L# ^0 N# R
Final Settlement
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CAR A:7 s3 U% W7 F/ P9 H7 G) P
Year -
5 ~" H5 M2 L6 `8 JMaker/Model -: R4 O4 g7 d" @0 w
Serial (VIN) # -( G( y1 w/ V" e. w! T
Plate Number:/ ^- L7 X; h- [& d
Driver Name: (called driver A in this document)( N, ^. i$ C4 }' X5 e3 i0 f& C
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CAR B:% d% C, d4 f: ?& B
Year -+ d; l, @5 U [) o
Maker/Model – ]+ {+ a* U1 A9 G
Serial (VIN) # -
" w' m; _/ T& ?( }% \1 ^. y; uPlate Number:2 B. l0 R* L- f9 Q# @1 H
Driver Name: (called driver B in this document)
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7 X; _0 z0 [7 vIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.9 g$ u. y) A& Y) X
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The driver B has paid
, A4 B7 b, }& p1. Bumper repair: $" {, j; I+ p$ @/ L5 w
2. Other Compensation: $
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+ d6 p7 s+ i& Q4 cdriver 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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) W# A) s. U7 D" S/ H3 WDriver A:& q4 C/ X) Z) P5 {+ C
3 n4 U7 f' ` W' x( C" b$ \Signature Date:6 ~( Q7 o0 f: i V2 c
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Driver B:% _; R7 E8 l u' i8 Y
) X8 T- _! u* j* U, [$ A9 _Signature Date:
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Witness: h r; l/ X* _2 J
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Signature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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