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
Date
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
Registration Exp
Fitness Expiration Date*

DayMonthYear
Fitness 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/
Should be Empty:

JAMAICA AUTOMOBILE ASSOCIATION