Form Vs-124w - Renewal Application Of A Body Damage Estimator License
Download a blank fillable Form Vs-124w - Renewal Application Of A Body Damage Estimator License in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Vs-124w - Renewal Application Of A Body Damage Estimator License with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1RENEWAL APPLICATION OF
VS-124W (10/15)
A BODY DAMAGE ESTIMATOR LICENSE
FOR OFFICE USE ONLY
CIR
CIA
CID
NOTE: If you are currently licensed by the Insurance Department, as of
January 1, 1996, you will not have to be licensed by this Department.
If you do not hold an insurance adjustor’s license, complete this form.
INSTRUCTIONS:
1.
This form is for renewals ONLY. Do not use it for original applications.
2.
Answer all questions; we will return incomplete applications.
3.
The three-year certification fee is $150. Make check (no starter checks) or money order payable to the Commissioner
of Motor Vehicles and attach it to this application.
4.
Return the completed application with check or money order to: Bureau of Consumer and Facility Services,
At tn: Certification Unit, PO Box 2700 - Albany NY 12220-0700; Telephone: (518) 474-7998.
ç
BDE LICENSE NO.:
CURRENT EXPIRATION DATE:
1
ç
CLIENT IDENTIFICATION NUMBER (from NYS Driver License)
2
SOCIAL SECURITY NUMBER
(as required by the New York State Tax Law)
ç
3
____ ____ ____ ____ ____
____ ____ ____ ____
____ ____ ____ ____ ____ ____ ____ ____ ____
ç
o
o
4
Has your name changed in the last three years?
Yes
No
If “Yes”, print your correct name, date of birth and sex in the spaces provided below. If “No”, go to Question 5.
LAST NAME
FIRST
M.I.
DATE OF BIRTH
SEX
Male
Female
Month
Day
Year
o
o
ç
o
o
5
Has your address changed in the last three years?
Yes
No
If “Yes”, print your new address in the spaces provided below. If “No”, go to Question 6.
MAILING ADDRESS (Include Street No., Rural Delivery, Box and/or Apt. No.)
CITY OR TOWN
STATE
ZIP CODE
COUNTY
ç
o
o
6
Have you been convicted of any felony or misdemeanor in the past three years?
Yes
No
If “Yes”, give details below:
(Applicants will not necessarily be rejected because of a conviction record. Each application will be reviewed on an individual basis.)
Date of
Date of
Violation
Nature of Violation
Conviction
Disposition & Fine
Court Location
Section 398(d) of the Vehicle & Traffic Law provides for the licensing of motor vehicle body damage estimators. Anyone who
has such a licenses agrees to comply with the rules and regulations promulgated by the Commissioner of Motor Vehicles.
Failure to comply to comply with these rules and regulations may result in the revocation of this license. Notify this office of
any change in your address.
FALSE STATEMENTS MADE ON THIS APPLICATION ARE PUNISHABLE UNDER THE PENAL LAW.
ç
SIGN NAME IN FULL - DO NOT PRINT - No Nicknames
WORK TELEPHONE NO.
DATE
7
ç
(
)
*VS-124*
reset/clear
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Mv-664.1ch - Application For A Parking Permit Or License Plates, For People With Severe Disabilities (chinese)
Legal
Form Mv-664.1i - Application For A Parking Permit Or License Plates, For People With Severe Disabilities (italian)
Legal
Form Mv-664.1r - Application For A Parking Permit Or License Plates, For People With Severe Disabilities (russian)
Legal
Form Mv-664.1fc - Application For A Parking Permit Or License Plates, For People With Severe Disabilities (haitian Creole)
Legal
Form Mv-664.1k - Application For A Parking Permit Or License Plates, For People With Severe Disabilities (korean)
Legal
Related Categories
Parent category: Legal