 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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Settlement Disclosure/ x# |5 M# k2 Y" c9 F$ M6 w
Final Settlement
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3 {- ]' B4 a& s- O6 Z9 _2 N3 iCAR A:
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Maker/Model -% L! U9 I8 [ _, c
Serial (VIN) # -
2 a1 ~8 Z, _. Y) N: [" aPlate Number:
" Y# ?+ |$ w7 R2 s' C" GDriver Name: (called driver A in this document)) J5 E; @" V- h/ A$ P
0 i" B9 _5 }" m! ]! ICAR B:8 g. g0 }3 F' i u
Year -! T5 E* t* W* T5 J1 x- j( s
Maker/Model –' i0 J* ^2 h: S1 _ ^5 U. M* N
Serial (VIN) # -
( ~' S5 r8 g( \. W- b& ~, q& TPlate Number:, ~/ L# ~( ?/ p
Driver Name: (called driver B in this document)
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* ?! X+ u+ r2 u0 J9 KIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.0 {; }0 z* n! F: a! ]: G' M
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The driver B has paid0 }* e8 b; c) R; K! D
1. Bumper repair: $
8 G/ i; {& f& C0 ~$ l2. Other Compensation: $' ? t/ x+ `! K4 n3 @/ r7 r% H% p# L
% a: x$ b. G. i7 |& a/ K- 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.1 y( l0 B, k: y
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Driver A:
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8 G- V5 S$ I% ^3 o5 [, S' rSignature Date:& F( T& i+ b+ f8 M
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2 s: I+ w' ?. W6 C/ g* oDriver B:
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) x+ w- e8 @- a. f# GSignature Date:
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/ ?4 H8 S# W. w! I0 uWitness:( T4 U6 {4 R0 w0 P [, H" ]5 }* Z2 A
Q" ^" w+ Z7 r8 ?1 xSignature Date: |
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狗仔卡
发表于 2008-3-11 09:16
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