JAA - ATL Member Enrolment

JAMAICA AUTOMOBILE ASSOCIATION

NEW MEMBER FORM - ATL
MEMBER INFORMATION
First Name
First Name
Last Name
Surname
TRN Number
TRN/ Drivers License Number
Gender
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Primary Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address (Parish)
VEHICLE INFORMATION
Vehicle Make
Vehicle Model
Vehicle Year
Plate Number
Licence Plate of Vehicle
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
SUBMISSION INFORMATION
Card Delivery/Pick-Up
Choose a preferred mode to receive the card
Month of Sale/Delivery
Year of Sale/Delivery
Submitted by
Sales Representative email address
example@example.com
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