Sponsored Member Enrollment

JAMAICA AUTOMOBILE ASSOCIATION

NEW MEMBER FORM - FIDELITY MOTORS
First Name
First Name
Middle Name
Last Name
Surname
TRN Number
TRN/ Drivers License Number
Gender
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDOB
Mailing Address

Street Address

Street Address Line 2

CityParish

Postal Code/ P.O.
Primary Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Alternative Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Emergency Contact Name

First NameLast Name
Emergency Contact Telephone Number
Please enter a valid telephone number.Format: (000) 000-0000.

VEHICLE INFORMATION
Vehicle Make
Vehicle Model
Vehicle Year
Plate Number
Licence Plate of Vehicle
Drivers Licence Expiration Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDrivers Licence Exp
Registration Expiration Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearRegistration Exp
Fitness Expiration Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearFitness Exp
Insurance Company
Policy Type
Insurance Expiration Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearFitness Exp
Card Delivery/Pick-Up
Choose a preferred mode to receive the card
Submission Information
Membership Period
Name of Sales Agent

First NameLast Name
Submitted by
example@example.com
Submitted by:
Complete this box only if the person submitting form is not sales agent
The Jamaica Automobile Association (JAA) processes personal data in accordance with the Jamaica Data Protection Act. For information on how we collect, use, and protect your personal data, please see our Privacy Notice available at www.jngroup.com/privacy-notice/
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JAMAICA AUTOMOBILE ASSOCIATION