Driver License
Application Request
Complete a separate form for each record requested. You may photocopy this form for your convenience. 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." Please supply a separate check for each record request and DO NOT SEND CASH. Please note that the
turnaround time is approximately 3-4 weeks.
MAIL TO:
New Jersey Motor Vehicle Commission
Business & Government Services
225 East State Street
PO Box 146
Trenton, NJ 08666-0146
*If you have any questions or need to obtain the status of a request sent by mail, please call 609-292-4102.
ALL APPLICANTS MUST COMPLETE SECTIONS A, B, C, AND E OF THIS FORM. COMPLETE SECTION D, IF APPLICABLE.
(Please print clearly)
SECTION A – Applicant’s Information
**Please put your CURRENT ADDRESS. Your documents will be mailed to the address that you provide in this section. Mail from
the NJMVC is not forwarded.
Applicant's Name:
Your File or Claim #:
Applicant Type:
Individual/Business
Government/Law Enforcement Entity
Phone #:
Email Address:
Street Address:
City:
State: ZIP Code:
Applicant Driver License or Government Issued ID Number (Please include a photocopy of your ID):
For Government or Law Enforcement Applicants: Please 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.
SECTION B - Information Requested On
NJ Driver License Number (If you do not have the Driver’s License number, you MUST supply name, DOB, gender, and address):
Name: Date of Birth:
M (Male) F (Female) X (Unspecified)
Street Address:
City: State: ZIP Code:
SECTION C - Information Requested. Check all that apply and include the specific date you want covered for each record if
applicable. Please supply separate checks for each record
$15
PER SEARCH
Copy of
Driver License Application (Includes issue date of driver license and name and address of driver; some information is purged,
as required by law. MVC will give oldest available). If no date is supplied, you will only receive the name and address.
Address History of Driver
DATE YOU WANT
COVERED:
Month Day Year
Visit us at www.NJMVC.gov
DO-11 (R1/24) Page 1 of 3
New Jersey is an Equal Opportunity Employer
Business or Government/Law Enforcement Entity Name (if applicable):
Driver Information
Application Request
Visit us at www.NJMVC.gov
New Jersey is an Equal Opportunity Employer
DO-11 (R1/24) Page 2 of 3
PLEASE READ THE BELOW SECTION OF THE NEW JERSEY DRIVER PRIVACY PROTECTION ACT, INITIAL NEXT TO THE PERMITTED USE(S) 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.
USES PERMITTED BY N.J.S.A. 39:2-3.4(c)
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.
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 form the original owner records of
motor vehicle manufacturers.
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.
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.
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.
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.
7. For use in providing notice to the owners of towed or impounded vehicles.
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.
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:
10. For use by any applicant, if the applicant demonstrates it has obtained the notarized written consent of the individual to the
information pertains.
*Please note: 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.
Please 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.
Please include proof of authorization to tow or impound vehicles.
Please include supporting documents for intended use i.e. declaration page.
Please include a description of the initiative or research on official letterhead
Please include the Docket number and a letter from the client confirming that you have been retained. Please provide an explanation
if no docket number has been assigned. If no Docket number is available, please submit the case file number on Attorney letter
head and include a copy of the accident report.
Please 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.
Please include the documentation supporting your request if the information is to be used for motor vehicle emissions, recalls or
advisories, etc.
If acting on behalf of a government agency, please provide proof of retention.
SECTION D – Purpose for the Request (required ONLY when requesting another’s record)
Driver Information
Application Request
Visit us at www.NJMVC.gov
New Jersey is an Equal Opportunity Employer
DO-11 (R1/24) Page 3 of 3
Explanation of reason
Please explain in detail your reas
on for requesting this information and how you plan to use it. If involving a lawsuit,
please state the type of lawsuit and y
our 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.
I hereby certify that the foregoing statements and submitted supporting documents are true. I understand that if any of the statements or
submitted supporting documents are willfully false, I am subject to punishment. I have read N.J.S.A. 39:2-3.3, et seq. (NJDPPA) and I have
initialed all the permitted purposes that apply to my request for online access. I will only use any personal information contained in records I
have requested as permitted by the NJDPPA.
I 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 I am requesting another’s record, I certify that:
1.
Use of the information provided by the NJMVC pursuant to this Application will only be for the purposes explicitly set forth in this
Application;
2.
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 I shall not provide such information to any
person or entity that seeks to use such information for any of these purposes;
3.
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;
4.
In the event of a breach of any of the security obligations or other event requiring notification under applicable law, I 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.
___________________________________________
Date
____________________________________________
Signature of Applicant (original signature only – signature
Stamps are unacceptable)
SECTION E – Terms and Conditions
