Driver History Abstract
Application Request
Visit us at www.NJMVC.gov
New Jersey is an Equal Opportunity Employer
DO-21 (R8/21)
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.
If actin
g on behalf of a Federal, State, or Local agency, please include a copy of an individual release consent form, the agreement with the client,
or other proof that you have been retained to conduct an investigation.
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.
Please
include the documentation supporting your request if the information is to be used for motor vehicle emissions, recalls, or advisories, etc.
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.
Please
include a copy of the individual release consent form.
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
judgements and orders, or
pursuant to an order of a Federal, State, or Local court.
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 letterhead and include a copy of the
accident report.
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 organ procurement organizations as aggregated, non-identifying
information.
Please
include a description of the initiative or research on official letterhead.
6. For use by an insurer or insurance support organization, or by a self-insured entity, or its agents, employees, or contactors, in connection with
claims investigation activities, antifraud activities, rating or underwriting.
Please
include supporting documents for intended use.
7. For use in providing notice to the owners of towed or impounded vehicles.
Please
include proof of authorization to tow or impound 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.
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.
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 whom
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.
SECTION D – Purpose for the Request (required ONLY when requesting another’s record)
