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British Columbia Canada Driving Record Release
(REV.-3 3/02)
Licensing Support Services MVR Account No.___________
BRITISH COLUMBIA
__________________________
DO NOT WRITE ABOVE LINE
DRIVER’S LICENSE ABSTRACT REQUEST or CERTIFIED RECORD(S)
Please print
SEARCH FEE ENCLOSED SEARCH FEE
$ , | | . | | (CDN.)
OR ACCOUNT NUMBER | | | | | |
NAME OF
COMPANY___________________________________________________________
ADDRESS TO FORWARD STREET / PO BOX /
RR#____________________________________
DRIVING RECORD(S)
TO:________________________________________________________
CITY / PROVINCE / STATE POSTAL CODE / ZIP
CODE_____________________________
Names of companies who will view driver abstract MUST be
listed below BEFORE driver signs
COMPANY NUMBER
1______________________________________________________________
COMPANY NUMBER
2_____________________________________________________________
COMPANY NUMBER
3______________________________________________________________
COMPANY NUMBER
4_____________________________________________________________
COMPANY NUMBER
5_____________________________________________________________
COMPANY NUMBER
6____________________________________________________________
COMPANY NUMBER
7____________________________________________________________
COMPANY NUMBER
8____________________________________________________________
Driver
information_____________________________________________________
Name of Driver:
I,
_____________________________________________________________________________________________________________________
LAST FIRST MIDDLE
Address of Driver:
of
____________________________________________________________________________________________________________________
STREET / PO BOX / RR# CITY, PROVINCE POSTAL CODE
the holder of British
Columbia Driver’s Licence Number:
___________________________________________________
Date of Birth: ______________________________________________,
do hereby authorize the above-named
company to obtain from the ( _______________YEAR MONTH DAY)Insurance Corporation
of British Columbia, Licensing Support Services, a copy of my driving record
(abstract).
________________________________________
_____________________________________________
ORIGINAL SIGNATURE OF DRIVER DATE:
_____________________________________________________________(YEAR MONTH DAY)
(PLEASE USE BLUE INK)
Abstract requests with photocopy or facsimile
signature received
at Licensing Support Services will NOT be
processed.
(REV.- 1 2/02)
Instructions for British Columbia Release Form
Please provide MVR Account Number in upper right
corner
Leave top box blank
Fill in second box
Driver to fill out and sign Driver information
section in blue ink
Please mail original to MVR’s Inc.
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