VSA 18 (07/01/2020)
BENEFICIARY TRANSACTION
REQUEST
Purpose: Use this form to add, change, or remove a beneficiary on a certificate of title.
Instructions: Complete this form and return to any DMV customer service center. DMV may request proof of any information
provided.
OWNER INFORMATION
BENEFICIARY INFORMATION
Complete the following information to ADD a beneficiary to the title of your vehicle
NOTE: You can only have ONE beneficiary on the title of your vehicle.
BENEFICIARY TO ADD FULL LEGAL NAME (last, first, middle, suffix) DMV CUSTOMER NUMBER / SSN
Complete the following information to REMOVE a beneficiary from the title of your vehicle
BENEFICIARY TO REMOVE FULL LEGAL NAME (last, first, middle, suffix) DMV CUSTOMER NUMBER / SSN
Complete the following information to CHANGE the beneficiary that is currently on the title of your vehicle
DMV CUSTOMER NUMBER / SSNBENEFICIARY FULL LEGAL NAME CURRENTLY ON TITLE (last, first, middle, suffix)
DMV CUSTOMER NUMBER / SSNCORRECTED BENEFICIARY FULL LEGAL NAME TO ADD TO TITLE (last, first, middle, suffix)
CERTIFICATION
OWNER SIGNATURE
DATE (mm/dd/yyyy) OWNER NAME (print)
I certify and affirm that all information presented in this form is true and correct, that any documents I have presented to DMV are genuine, and that the
information included in all supporting documentation is true and accurate. I make this certification and affirmation under penalty of perjury and I
understand that knowingly making a false statement or representation on this form is a criminal violation.
IMPORTANT INFORMATION (VA Code § 46.2-633.2)
■ To transfer ownership, the beneficiary must apply for a certificate of title within 120 days of the death of the owner(s).
■ For an owner to successfully add a beneficiary:
• Motor vehicles, trailers or semitrailers can NOT have a recorded lien on the title.
• When a lien is added the beneficiary will be removed.
• The beneficiary MUST be an individual, NOT a business entity.
OWNER FULL LEGAL NAME (last, first, middle, suffix) DMV CUSTOMER NUMBER / SSN
RESIDENCE/HOME ADDRESS (Apt. # if applicable) CITY STATE ZIP CODE
MAILING ADDRESS (if different from above) CITY STATE ZIP CODE
VEHICLE INFORMATION
VEHICLE IDENTIFICATION NUMBER (VIN)
This form can not be processed without the following information.
VEHICLE TITLE NUMBER
OWNER SIGNATURE
DATE (mm/dd/yyyy) OWNER NAME (print)
OWNER SIGNATURE
DATE (mm/dd/yyyy) OWNER NAME (print)
OWNER SIGNATURE
DATE (mm/dd/yyyy) OWNER NAME (print)
OWNER SIGNATURE
DATE (mm/dd/yyyy) OWNER NAME (print)
OWNER SIGNATURE
DATE (mm/dd/yyyy) OWNER NAME (print)
