 鲜花( 3)  鸡蛋( 0)
|
这里有一份
自己酌情改改就可以了。
/ e: ]! Z* M O
4 `+ L1 c/ m$ ^3 tSettlement Disclosure+ L/ W5 k5 f. [6 n: m+ k
Final Settlement
1 G) G9 C8 S3 E/ V; n
7 G" }+ {$ l* U$ G- TCAR A:
/ r9 l; f( |' B- GYear -1 T# _# h% r: m
Maker/Model -& h1 x/ D8 k5 D+ _9 f# k
Serial (VIN) # -
0 I$ N0 j; m5 o8 K9 z$ z {: nPlate Number:6 U3 s }& `; I3 X3 M9 A9 X! l
Driver Name: (called driver A in this document)! A j+ O; e$ r6 D: Y8 @6 C- }0 o2 {0 C
) A/ W9 J+ R$ z$ O2 _% iCAR B:
! i- l9 C) @2 V3 qYear -& D+ D, M' [" `% ~3 D! T7 A, u4 Z
Maker/Model –
* ]9 e% }, [8 H# c$ ~Serial (VIN) # -) O( }8 N4 o' Y- T+ w
Plate Number:. o4 ~3 B. Q* w" M" K7 T7 s
Driver Name: (called driver B in this document): Z1 _+ A* }0 F8 ?1 `
0 `: _( K/ d$ }" X1 g$ x# N
In the afternoon of Nov. 7th, 2007, car B hit the back of car A., Z) @0 J2 c; P0 i* {
- n; @$ |" T4 s+ s+ KThe driver B has paid
( ^1 a' Z6 Q. | f/ t1. Bumper repair: $
& w3 F8 h) w( i# m! z( q2. Other Compensation: $
3 p9 a. X2 c3 \/ f8 s& H6 y
5 B* h( u/ e3 |2 K8 x& _% ?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.- @$ j4 ^) F4 ~5 I# I! Z% p2 m
! b2 ^* G4 w: v* r, g4 @
Driver A:* C7 B R, d$ B: w4 W d3 v- `. z+ H
9 }& [# \3 X9 G/ q8 u* V' ?
Signature Date:; z% G) y2 C- i! Y! ]$ }( i7 s
+ V! s& ] r8 j: w3 j5 C5 i4 q
7 I& Q0 S% M6 e! L6 U! ]8 C% pDriver B:
( q3 K4 \$ f3 @1 M1 T7 N
, a* r. R8 F0 k, n- v& ]Signature Date:7 q$ b3 g Y- Z( r k: G* q$ @
6 k! @: o. D6 y& D) W
& [8 ^5 `( b8 L( bWitness:/ Y& O/ ^0 F' ^; L
7 B; c5 Y6 G; |: S. Z, I
Signature Date: |
|