Form Mv-18g - Service Member'S Affidavit For Mandatory Insurance Relief Page 2
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2MV-18G Instructions (Revised 04-04)
Instructions for Completing Service Member’s Affidavit for Mandatory Insurance Relief (Form
MV-18G)
1.
Service Member’s Full Legal Name
a.
Enter the service member’s full legal name. A natural person’s full legal name is his or her
complete name as it appears on his or her valid driver’s license or state-issued identification card.
2.
Driver’s License Number & State of Issue
a.
Enter the service member’s current valid driver’s license number or state-issued identification
number and the name of the state issuing the driver’s license or state-issued identification card.
3.
Vehicle Identification Number (VIN)
a. Enter your vehicle’s identification number (VIN) as shown on your vehicle’s VIN plate. The VIN
on your vehicle’s VIN plate should match the VIN on your vehicle’s registration certificate (a/k/a
tag receipt) and title.
4.
Year Model & Make of Vehicle
a. Enter the year model and make of your vehicle (i.e. 2001 Dodge, 1998 Toyota, etc.)
5.
Location Where Vehicle Was Stored or Parked
a. Enter the name of the business or the name of person and their address where the vehicle was
stored or parked (i.e. Vehicle Storage Company, 123 Anywhere St., Atlanta, GA 30303, John Doe,
456 Nowhere St., Savannah, GA 30319, etc.).
6.
FROM (Date In Storage/Parked)
a. Enter the date (month, day and year) when the vehicle was first parked or stored at the location
shown in the previous field entitled “Location Where Vehicle Was Stored or Parked”.
7.
TO (Date Out of Storage/Parked)
a. Enter the date (month, day and year) when the vehicle was removed from storage or no longer
parked at the location shown in the above field entitled “Location Where Vehicle Was Stored or
Parked”.
8.
Service Member’s Signature
a. The service member completing this form must sign certifying all the information shown on this
form is correct.
9.
Date
a. The service member should enter the date (month, day and year) he or she signs this form.
10.
Sworn to and Subscribed Before Me
a.
The notary should enter the date (month, day and year) he or she witnessed the signing of this
form.
11.
Notary’s Printed Name
a. The notary public should print his or her full legal name. A natural person’s full legal name would
be his or her complete name as it appears on his or her valid driver’s license or state-issued
identification card.
12.
Date My Notary Commission Expires
a. The notary public should enter the date his or her notary commission expires.
13.
Notary’s Signature & Seal or Stamp
a. The notary public should sign and affix his or her seal or stamp. The information affixed to this
form with the notary’s seal or stamp must be legible.
14.
Date
a. The notary should enter the date (day, month and year) he or she signs this form.
15.
Printed Name
a. The service member’s commanding officer should print his or her full legal name. A natural
person’s full legal name would be his or her complete name as shown on his or her valid driver’s
license or state-issued identification card.
16.
Rank/Position/Title
a. The service member’s commanding officer completing this form should enter his or her rank,
position or title.
17.
Date
a. The service member’s commanding officer completing this form should enter the date he or she
signs this form.
18.
Signature
a. The service member’s commanding officer completing this form must sign this form certifying the
information shown regarding the service member is correct.
19.
Military Reservation (Base)
a.
The service member’s commanding officer completing this form must enter the name of his or her
military reservation (base) where he or she is stationed.
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