Fillable Driver Abstract Request Form -Yukon Motor Vehicles printable pdf download

Driver Abstract Request Form -Yukon Motor Vehicles

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DRIVER ABSTRACT REQUEST FORM

DRIVER INFORMATION

Name: _________________________________________

_________________________________________

____________

Last Name

First Name

Middle Initial

Yukon Driver’s Licence No. (if known): _______________________________________ Date of Birth: _________________

yyyy/mm/dd

Phone Number: _______________________________________

DELIVERY INSTRUCTIONS

Mailing Address: _________________________________________________________________________________________

Street Adress

_________________________________________________________________________________________________________

City

Province/Territory

Postal Code

Fax Number: ( _____ ) _________________ E-mail Address: ___________________________________________________

DRIVER ABSTRACTS

Driver Abstracts are issued in 3 stages (3 year, 5 year and life). Most insurance companies require a 5 year abstract.

Unless otherwise stated a 5 year abstract will be issued.

3 year

5 year

life

PAYMENTS

PLEASE DO NOT E-MAIL CREDIT CARD INFORMATION

There is a $10.00 fee for each abstract requested. All payments payable to Government of Yukon. If mailing your

request, please pay by cheque or money order to the address below. If faxing your request, upon receipt of this form,

Motor Vehicles staff will contact you for payment.

DO NOT ATTACH YOU PAYMENT INFORMATION TO THIS FORM

There is a 24 to 48 hour turnaround time for faxed/emailed requests.

No cardholder information such as names, account numbers, or other information embossed, encoded or appearing in any manner on the card will

be used for any purpose other than in respect to this transaction.

Yukon Motor Vehicles cannot guarantee the confidentiality of an e-mail response. E-mail is not considered a secure method of communication and

personal information could potentially be read by an unauthorized person or persons. Emails sent to and from work computers could potentially

be read by an employer and emails sent to a home address may be read by anyone with access to that home computer such as other members of

the household. Generally, email is not encrypted and could be intercepted by any of the internet service providers that handle the emails from the

sender to the recipient.

________________________________________________________________

__________________________________

Signature

Date (yyyy/mm/dd)

Mail Request to:

Fax Request to:

E-mail Request to:

Yukon Motor Vehicles

(867) 393-6220

Fully completed and signed forms

Box 2703 W-22

Yukon Motor Vehicles

can be scanned and e-mailed to

Whitehorse, Yukon

Motor.Vehicles@gov.yk.ca

Y1A 2C6

PLEASE DO NOT E-MAIL CREDIT CARD INFORMATION

YG(5947EQ)F1 12/2015

Clear

Driver Abstract Request Form -Yukon Motor Vehicles

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