Motor Vehicle Record (MVR) Consent Form

Motor Vehicle Record (MVR) Consent Form
To meet insurance requirements, all drivers must submit a signed MVR consent form. This form authorizes the insurance agent and/or insurance company to review your personal driving record. Upon the review of MVR, the insured will be notified of your eligibility status to drive a company vehicle.

Information obtained by the insurance agent and/or insurance company will not be released to any other parties.
Named Insured
Full Legal Name of Driver: (Print)
Driver’s License Number
State Issued
Date of Birth

MonthDayYear
Date
Driver Signature

Clear
Date

MonthDayYear
Date
I hereby authorize the insurance agent/insurance company to review my driving record
Should be Empty: