 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。* o9 Z' @2 j) }% q+ w
/ J' u6 [( q: X% F! b, ^/ g$ z5 Z; m8 o RSettlement Disclosure% ^$ h, S" C/ t& M6 e
Final Settlement
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9 {, S2 V" J- L9 L1 }CAR A:
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& R- J" t& z% z7 gMaker/Model -, R) i3 O. ^% q3 N* d$ v/ G; D& X
Serial (VIN) # -5 H& g/ g: Q7 t
Plate Number:
4 e! U, X6 K" L" j1 E; j( ~Driver Name: (called driver A in this document)1 X4 S: S4 E8 `3 u! h0 o
5 Q: Q! X/ `/ _4 D8 c( I4 ]' X# OCAR B:' m! o& [- L+ O" O/ Q
Year - \, r+ o' P, X7 t |
Maker/Model –* `+ ?7 e- l/ S e
Serial (VIN) # -
+ {% a9 X! f: C- dPlate Number:
/ a0 E" O7 Z, J0 d& M' O8 L7 kDriver Name: (called driver B in this document)
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.0 b7 l6 t" |) I; C* ]* p
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The driver B has paid
2 _$ K3 j% K6 r: y% t! V1. Bumper repair: $: _+ e3 x8 U V9 {2 f
2. Other Compensation: $, N7 r& z, V3 K" \ @0 f d, ]) {$ L* x
' _3 e$ w' F& l+ X3 Hdriver 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.$ I% O: x& M- d0 U# v- _
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Driver A:2 K7 r4 L5 L. Y3 V1 ~
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Signature Date:. H+ S4 `+ K7 c, [) \9 n$ }* g
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Driver B:
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Signature Date:/ @1 w% ?7 b5 |4 X
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! F2 P- g" P5 XWitness:
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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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