Form Reg3388 – Fill Out and Use This PDF

Driver Abstract Statement of Intent

This form is to be completed if a driver's abstract of a person is being received by someone other than that person. A "Driver Abstract" is the product name under which the Alberta Government releases specific information from a person's driving record, which contains:

l	Name	l	Height	l	Class	l	Licence Number	l	Expiration Date
l	Address	l	Weight	l	Issue Date	l	Current Demerit Points	l	Reinstatement
l	Date of Birth	l	Sex	l	MVID Number	l	Suspended Status		conditions (if any)

lList of violations (Descriptions, Demerit / Merit Points and Suspension Term)

lA Commercial Driver Abstract (CDA) includes Commercial Vehicle Safety Alliance Inspection (CVSA) information and all of the above information with the exception of date of birth, height, weight, and sex.

I / We,

Name of the person / organization requesting the driver's abstract

of					,
				Full Address
solemnly declare that I/We have received permission to request the:
	3 Year,	5 Year,	10	Year Driver Abstract (SDA),
	3 Year,	5 Year,	10	Year Commercial Driver Abstract (CDA),
of					.
			Name of the person whose driver's abstract is being requested

In accordance with the Alberta Motor Vehicle Information Regulation (AMVIR) (choose one of the following subsections):

5(1)(a) driver's abstract released to someone known to that person

I solemnly declare that:

lI have received valid written consent

lthe person is personally known to me and I am receiving the driver's abstract only to transfer it to that person

lafter receiving the driver's abstract I am fully responsible for it

lI am not acting as an agent or employee of any other person in this transaction, and that I am not compensated in any manner for receiving or transferring the driver's abstract to that person.

5(1)(b)(iii) driver's abstract released to employer or prospective employer

I/We solemnly declare that:

lvalid written consent has been received

lthe driver's abstract will be used for employment purposes only

lafter receiving the driver's abstract I am fully responsible for it .

5(1)(b)(iv) driver's abstract released to parent or guardian of a minor

lconsent is not required.

5(1)(b)(v) driver's abstract released to a lawyer representing the driver

I/We solemnly declare that:

lvalid written consent has been received

lthe driver's abstract will be used to represent the client

lafter receiving the driver's abstract I am fully responsible for it.

I/We agree that Alberta Registries and/or the registry agent are not liable for any damages or losses however caused, in respect to any defect, error or omission in the driver's abstract, or use of the driver's abstract.

Signature of the authorized individual			City/Town/Village		Province/State
Date (yyyy-mm-dd)			Name of Witness (PRINT)		Signature of Witness

In accordance with s. 33(c) of the Freedom of Information and Protection of Privacy Act, the Traffic Safety Act, and the Access to Motor Vehicle Information Regulation, specific personal information is collected to determine the recipient's authority to request the information under AMVIR and to confirm the identity of the consenting individual, of the recipient, and of the authorized employee of the recipient (if the recipient is an organization). The registry agent stores this form for one year. The form is used to monitor and audit the release of information and to conduct investigations if the Registrar receives complaints about the release. Questions about the collection of this information can be directed to a Service Alberta Information Officer at 780-427-7013, toll free 310-0000 within Alberta. Alternatively, questions may be mailed to Box 3140, Edmonton, AB T5J 2G7, attention Data Access and Contract Management Unit (DACMU).

REG3388 (2012/03)