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这里有一份
自己酌情改改就可以了。2 E( e) p H7 a! J3 b3 G$ d! G
H. i. t4 x8 v( Q* R# ^6 jSettlement Disclosure
6 A+ K( N3 @$ V6 t& m# T: }/ TFinal Settlement/ e/ {: y9 c+ G7 ^6 z, Q& m
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CAR A: W1 l* f6 T6 m9 G: S
Year -2 {: G5 K7 n1 k3 S% f# N% r, L
Maker/Model -
7 U) M& c, _+ ~& W' A, ?( p+ }3 ASerial (VIN) # -
8 [( J+ z- v9 J6 b8 s VPlate Number:6 y7 m8 a7 d. Z
Driver Name: (called driver A in this document) Y; Y( r! _0 x# w
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CAR B:7 ?% j. B9 L$ Z1 T p6 k
Year -
" j- {) K# K, {, H1 e! a% ZMaker/Model –
8 @% X, I8 H* L8 oSerial (VIN) # -
% K5 G4 |- q+ V. w0 g0 gPlate Number:
$ C; y; C8 t& D# d! K9 G5 \6 ^ yDriver Name: (called driver B in this document)2 E- w' `9 L$ {
2 d. Z! u9 X" H. L6 F' x' MIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid
0 [. G( V1 K$ i! T1. Bumper repair: $& ]6 k1 y# e& b
2. Other Compensation: $
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$ D" V$ I3 G9 L0 o- Kdriver 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.9 ?5 Z) C- G$ ?6 L n8 C9 L1 o1 F
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Driver A:
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6 c/ t6 ^+ u% r, ASignature Date:
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Driver B:& p% Y7 X5 n: P0 \
" l% p' q3 j, S6 M+ ^' aSignature Date:4 X; ~- G8 i) s
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Witness:
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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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