 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
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CAR A:
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Maker/Model -
0 X6 [& D% x$ \( |2 I; e! eSerial (VIN) # -
7 M: m# l( F0 I- J& C& |( u8 ~Plate Number:
, c" |5 `' X3 a) t9 dDriver Name: (called driver A in this document)
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; a9 @+ {1 z2 K- n1 E% d: n6 mCAR B:
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Serial (VIN) # -
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Driver Name: (called driver B in this document)0 [9 k X5 L" Z7 Y
1 I7 q( z8 z! o: T- c7 oIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.& n6 E2 V. m5 B$ v7 D" n, p
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The driver B has paid+ M% x4 B: K3 Y8 g4 e
1. Bumper repair: $: Y" o* i0 R9 ^
2. Other Compensation: $
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( y- m m- v5 C- x0 P" ?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., m! D7 P N$ ]5 O
$ p u1 X1 Z. K) z1 |Driver A:
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* A% l; U8 J& H" ]' J! ESignature Date:
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Driver B:
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Signature Date:& B: c" p' [+ n( B! w
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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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