 鲜花( 3)  鸡蛋( 0)
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这里有一份
自己酌情改改就可以了。
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+ Q' @& n7 V+ M2 P; f5 k+ cSettlement Disclosure
! s3 G) ^( a+ @# t! d, fFinal Settlement
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CAR A:
$ b7 z2 \* D7 q5 R$ F @% ^/ EYear -
5 u' z2 H4 A/ C9 o# G I N# ]Maker/Model -! s' r3 c6 B; K ]! w3 ]2 F6 y L4 d
Serial (VIN) # -
* }7 b1 Q7 f N6 ZPlate Number:
2 h% P$ u* J' gDriver Name: (called driver A in this document)
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CAR B:
/ e4 h4 U$ o& ^5 N6 ^( fYear -
; g3 F# i: R7 v% e( [Maker/Model –5 W, w8 H$ o: u$ E" c/ d
Serial (VIN) # -8 J" G1 F7 e5 ^& p% Y5 p
Plate Number:
1 H0 a/ p# |4 Y- L" qDriver Name: (called driver B in this document)) j" w- t4 y: Z: f4 c4 T; K; P
2 c9 q* H3 D5 N6 y1 q2 e' ]( aIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.$ Y0 [ v4 ` H+ s8 O$ F7 c2 c, h0 C
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The driver B has paid
?6 Y, P( b% i- {/ R1. Bumper repair: $; W5 `2 c3 p5 b6 P
2. Other Compensation: $+ x4 J! ~. r( ]/ j* P1 {
$ N, E: _0 v h9 ndriver 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:
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1 Y" C& [% E% [7 f- Y. CDriver B:
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4 E! Y7 W' T9 ISignature Date:, M4 @: }; P: g- ^
$ N2 M7 O5 [+ h' p+ @: Q/ p& ?* q
* v- l! Z5 Q' I0 i9 u5 kWitness:2 b8 V* ~) S. Z1 d7 h) x9 V
: R- k- B* y. X# H4 _$ H. [# @8 ]; GSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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