DO-11A: New Jersey Vehicle Registration Application Request

All applicants must complete Sections A, B and D of this form, and Section C if it applies; print clearly.

Common mistake: In Section A, put your current address; your documents will be mailed to the address that you provide in this section, and mail from the NJMVC is not forwarded.

Enter the Applicant's Name and Your File or Claim #.

Under Applicant Type, mark Individual/Business or Government/Law Enforcement Entity, and enter your Phone #.

Enter your Email Address.

Enter the Business or Government/Law Enforcement Entity Name, if applicable.

Enter Street Address Line 1, Street Address Line 2 with the Apt/Unit #, the City, the State and the ZIP Code.

Enter the Applicant Driver License or Government Issued ID Number, and include a photocopy of your ID.

For Government or Law Enforcement Applicants, include a photocopy of your current Government issued Identification Card; otherwise, include a photocopy of your Driver License or a photocopy of a Passport, Birth Certificate, or any valid state or federally issued ID.

In Section B, Information Requested On, you must provide either a plate number or a VIN / HIN.

FEE: $15 PER RECORD SEARCH.

Enter the New Jersey License Plate Number and the Vehicle /Hull Identification Number (VIN / HIN).

Indicate the information that you require (you may select more than one): Insurance, Name and Address of Driver, License Plate Number, Registration Expiration Date and Vehicle Description.

Some information is purged, as required by law; the oldest available will be provided.

Under DATE YOU WANT COVERED, enter the Month, Day and Year.

If you are requesting a record that is not your own, you must complete Section C.

Section C, Purpose for the Request, is required only when requesting another's record.

Read the below section of the New Jersey Driver Privacy Protection Act, initial next to the permitted uses that apply to your specific use of the MVC records, then provide a written explanation of the reason for your request and intended use of the information.

The uses listed are the uses permitted by N.J.S.A. 39:2-3.4(c).

Use 1: for use by any government agency including any court or law enforcement agency carrying out its functions, or any private person or entity acting on behalf of a Federal, State or Local agency in carrying out its functions.

If acting on behalf of a government agency, provide proof of retention.

Use 2: for use in connection with matters of motor vehicle or driver safety and theft; motor vehicle emissions; motor vehicle product alterations, recalls or advisories; performance monitoring of motor vehicles; motor vehicle parts and dealers; motor vehicle market research activities, including survey research; and the removal of non-owner records from the original owner records of motor vehicle manufacturers.

Include the documentation supporting your request if the information is to be used for motor vehicle emissions, recalls or advisories, etc.

Use 3: for use in the normal course of business by a legitimate business or its agents, employees or contractors, but only (a) to verify the accuracy of personal information submitted by the individual to the business or agents, employees or contractors; and (b) if such information as so submitted is not correct or is no longer correct, to obtain the correct information, but only for the purposes of preventing fraud by pursuing legal remedies against or recovering on a debt or security interest against the individual. Include a copy of the individual release consent form; a contract; a tow bill; or a repair bill from the repair shop with the person in question.

Use 4: for use in connection with any civil, criminal, administrative or arbitral proceeding in any Federal, State or Local court or agency or before any self-regulating body, including service of process, investigation in anticipation of litigation, and the execution or enforcement of judgments and orders, or pursuant to an order of a Federal, State or Local court. Include the Docket number and a letter from the client confirming that you have been retained. Provide an explanation if no docket number has been assigned. If no Docket number is available, submit the case file number on Attorney letter head and include a copy of the accident report.

For an abandoned vehicle request, include photos of the vehicle and VIN as referenced in the Abandoned Vehicle Packet, steps 8 and 9.

Use 5: for use in educational initiatives, research activities, and for use in producing statistical reports, so long as the personal information is not published, redisclosed, or used to contact individuals and, in the case of educational initiatives, only to organ procurement organizations as aggregated, non-identifying information. Include a description of the initiative or research on official letterhead.

Use 6: for use by any insurer or insurance support organization, or by a self-insured entity, or its agents, employees, or contractors, in connection with claims investigation activities, antifraud activities, rating or underwriting. Include supporting documents for intended use i.e. declaration page.

Use 7: for use in providing notice to the owners of towed or impounded vehicles. Include proof of authorization to tow or impound vehicles.

Use 8: for use by an employer or its agent or insurer to obtain or verify information relating to a holder of a commercial driver's license that is required under the "Commercial Motor Vehicle Safety Act," 49 U.S.C. App. §2710 et seq. Include a copy of an individual release consent form, a copy of the insurance policy, and a copy of the agreement if done on behalf of a client.

Use 9: for use in connection with the operation of private toll transportation facilities.

If your request does not fall under one of the above reasons, use 10: for use by any requestor, if the requestor demonstrates it has obtained the notarized written consent of the individual to whom the information pertains.

Common mistake: If you selected number 10, a "Notarized Authorization to Release Personal Motor Vehicle Information" (Form BGS/DO-21A) must be submitted and will not be accepted unless it is acknowledged by a Notary Public or Attorney at Law.

Only when requesting another's record (Section C), explain in detail your reason for requesting this information and how you plan to use it.

If involving a lawsuit, state the type of lawsuit and your relationship to the case.

The disclosure and use of personal information contained in the record you have requested is governed by the New Jersey Drivers' Privacy Act (NJDPPA), N.J.S.A. 39:2-3.3 et seq.

The NJDPPA provides that a person who knowingly obtains or discloses information from a motor vehicle record for any use not permitted by the Act is guilty of a crime of the fourth degree and can be held liable, in a civil action in the Superior Court, to the individual to whom the information pertains, including an award of actual damages, punitive damages, and reasonable attorney's fees and litigation costs.

"Personal Information" means information that identifies an individual, including an individual's photograph; social security number; driver identification number; name; address other than the five-digit zip code; telephone number; and medical or disability information, but does not include information on vehicular accidents, driving violations, and driver's status.

You certify that the foregoing statements and submitted supporting documents are true.

You understand that if any of the statements or submitted supporting documents are willfully false, you are subject to punishment.

You have read N.J.S.A. 39:2-3.3, et seq. (NJDPPA) and you have initialed all the permitted purposes that apply to your request for online access.

You will only use any personal information contained in records you have requested as permitted by the NJDPPA.

You agree to hold the New Jersey Motor Vehicle Commission (NJMVC) harmless in the event of any errors or omissions in the record and document(s) furnished under this application.

If you are requesting another's record, you certify that use of the information provided by the NJMVC pursuant to this Application will only be for the purposes explicitly set forth in this Application.

If you are requesting another's record, you certify that the information provided by the NJMVC pursuant to this Application will not be used for the purpose of commercial solicitation or marketing, political canvassing or campaigning or any similar purpose or objective, and that you shall not provide such information to any person or entity that seeks to use such information for any of these purposes.

If you are requesting another's record, you certify that if the information requested is to be used "in anticipation of litigation," pursuant to N.J.S.A. 39:2-3.4(c)4, personal information will only be used where litigation is imminent or foreseeable, or where the party on whose behalf the information is obtained has made the conscious decision to prepare a claim or defend against a probable claim.

If you are requesting another's record, you certify that in the event of a breach of any of the security obligations or other event requiring notification under applicable law, you shall comply with all applicable State and Federal laws that require notification of individuals in the event of unauthorized release of Person Information, or other event requiring notification, and assume responsibility for informing the NJMVC within twenty-four (24) hours and all such appropriate individuals, including the customer whose information is the subject of the release, in accordance with applicable law and to indemnify, hold harmless and defend the State of New Jersey from, and against any claims, damages, or other harm related to such breach or event. All communications must be coordinated with the State of New Jersey by contacting the NJMVC at 609-341-5777.

Common mistake: Sign on the Signature of Applicant line with an original signature only; signature stamps are unacceptable.

Enter the Date.

Common mistake: If you selected number 10, a "Notarized Authorization to Release Personal Motor Vehicle Information" (Form BGS/DO-21A) must be submitted and will not be accepted unless it is acknowledged by a Notary Public or Attorney at Law.

Mail to: New Jersey Motor Vehicle Commission Business & Government Services, 225 East State Street PO Box 146 Trenton, NJ 08666-0146.

For applications other than official Government use, the proper fee(s) must accompany each request in the form of a check or money order payable to: "New Jersey Motor Vehicle Commission." Supply a separate check for each record request and DO NOT SEND CASH. Complete a separate form for each record requested; you may photocopy this form for your convenience. The turnaround time is approximately 3-4 weeks.