Form VSA 12 at a glance
What it is: VSA 12 (10/29/2025), Affidavit in Lieu of Title Certificate, certifies unavailability of a current certificate of title for a motor vehicle or manufactured home due to loss, unlawful detainment or other legitimate circumstance.
Where and when to file: Submit all forms and applicable fees to DMV, attention "Titling Work Center" or present to any DMV Customer Service Center.
In order to register a motor vehicle, manufactured home, or to secure a new title for such a vehicle, the customer must submit a certificate of title. If unable to do so because the title is lost, unlawfully detained by someone who currently holds the title, or if the title is otherwise "not available", the customer may file an affidavit instead. Insurance Companies When an insurance company files an affidavit, the affidavit must indicate that the vehicle was acquired as a result of the claims process with the attached supporting documentation showing a claim was paid. Also the affidavit must include a description of the applicant's efforts to obtain the title from the previous owner. DMV will review the customer's applications and affidavit submitted along with information concerning the circumstances of the case. If DMV determines that the customer is entitled to registration and or titling, it will register the vehicle and issue a new registration card, license plate(s) and a certificate of title, salvage certificate or non-repairable certificate. Pursuant to Virginia Law, if the current certificate of title for a motor vehicle, trailer, semitrailer or manufactured home is unavailable due to legitimate circumstances, the steps must be followed:
Applicant (owner) must complete and submit form VSA 12, Affidavit in Lieu of Title Certificate.
What to bring and attach to Form VSA 12
Applicant must also complete and submit with this form one of the following: Application for Certificate of Title and Registration, VSA 17A -- Applicants use this form to apply for a title and/or to register a passenger vehicle, truck, motor home (RV), trailer, motorcycle, or for-hire vehicle.
Application for Certificate of Title - Manufactured Home, VSA 17B -- Applicants use this form to apply for a title to a manufactured home.
Salvage Certificate Application, VSA 56 -- Applicants use this form to apply for a salvage certificate.
Application For Non-Repairable Certificate, VSA 57 -- Applicants use this form to apply for a no-fee non-repairable certificate.
Submit the forms, applicable fees, title and sales and use tax, available original documents evidencing ownership and other supporting affidavits.
A filled-in Form VSA 12 example: an owner files after losing a car title
How to fill out Form VSA 12, box by box
Vehicle owner information
VEHICLE OWNER INFORMATION: Enter OWNER NAME (print) (if owner is an insurance company enter company name) and CO-OWNER NAME (print).
Enter owner customer number/FEIN/SSN and owner telephone number; for a co-owner, enter co-owner telephone number and co-owner customer number/FEIN/SSN.
Enter AUTHORIZED AGENT/REPRESENTATIVE NAME (print) (insurance companies only).
Vehicle information
Vehicle information: enter year, make, model, body type, color and vehicle identification number (VIN).
Supporting information
SUPPORTING INFORMATION - REQUIRED: describe the facts regarding your acquisition of the vehicle, the reason(s) you are unable to present a certificate of title for the vehicle, and a description of all efforts made to secure the title, in support of your application for a certificate of title, salvage certificate or non-repairable certificate for the vehicle described.
Certification and signatures
CERTIFICATION AND INDEMNIFICATION SECTION and AFFIDAVIT VERIFICATION SECTION MUST BE COMPLETED ON PAGE 2 OR FORM WILL NOT BE PROCESSED.
The owner(s) listed, being duly sworn, certify and affirm that all information presented in this form is true and correct, that any documents presented to DMV are genuine, and that the information included in all supporting documentation is true and accurate.
Sign the owner or authorized agent/representative signature and, for a co-owner, the co-owner signature, and enter the date (mm/dd/yyyy).
Notary verification
AFFIDAVIT VERIFICATION, NOTARIZATION: fill in State/Commonwealth of, city or county of, subscribed and sworn to before me on this day of (Month) (Year) by, in the city or county and state aforesaid.
Enter NOTARY SEAL/STAMP, REGISTRATION NUMBER, MY COMMISSION EXPIRES (mm/dd/yyyy), NOTARY PUBLIC NAME and NOTARY PUBLIC SIGNATURE.
More rules for Form VSA 12
Further, if the Commissioner of the Virginia DMV issues a certificate of title, salvage certificate or non-repairable certificate pursuant to my/our application and this affidavit, I/we hereby bind myself/ourselves, my/our heirs, assigns and personal representatives to indemnify and save harmless the said Commissioner, and his successors in office, individually and officially, for any loss or damage which may be asserted against him/them or which he/they may sustain as a result thereof.
If your situation is different
The owner is an insurance company
INSURANCE COMPANIES ONLY: Submit all forms and applicable fees to DMV, attention "Vehicle Branding Work Center".
IS OWNER AN INSURANCE COMPANY? If yes, vehicle MUST have been acquired as part of the claims process. Enter authorized agent/representative name in the space provided.
You are submitting a title application as a result of a law enforcement investigation
If you are submitting a title application as a result of a law enforcement investigation, you must use Form VSA 12LE. Form VSA 12 is not acceptable for this purpose.
Common questions about Form VSA 12
Where do I file it?
Submit all forms and applicable fees to DMV, attention "Titling Work Center" or present to any DMV Customer Service Center.
Are there fees?
Insurance companies must submit a $25.00 processing fee in addition to the fees associated with the forms listed. (checked November 1, 2026)
Is there a penalty?
The certification and affirmation are under penalty of perjury, and knowingly making a false statement or representation on this form is a criminal violation.
Sources
[1] Form VSA 12 (10/29/2025), Affidavit in Lieu of Title Certificate, Virginia Department of Motor Vehicles (the Official source link on this page).