Form Vs-117 - Application For A Motor Vehicle Body Damage Estimator License
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1
2FOR OFFICE USE ONLY
APPLICATION FOR A MOTOR VEHICLE
EIA
EIO
EIC
EIS
EIG
EID
BODY DAMAGE ESTIMATOR LICENSE
License Number
County
If you are not licensed by the NYS Insurance Department, complete this form.
OE
ADD
NOTE: Do not complete this form if you currently hold a NYS Independent
Y
N
N
Y
Adjuster’s License for General, Automobile-All Coverages, or
Automobile Damage and Theft Appraisal.
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FOR ORIGINAL APPLICATIONS
Answer ALL questions on pages 1 and 2 that apply to you, and SIGN the application on page 2. An estimator’s license
will be issued only to someone who has: at least one year of training and/or experience in body repair cost estimating for a
registered repair shop; or at least one year of training and/or experience in adjusting body repair claims for an insurance company
or independent adjuster; or a degree in automotive technology from an accredited college or university or vocational school, and
at least six months of experience in body repair cost estimating for a registered repair shop.
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TO AMEND OR REPLACE YOUR ESTIMATOR LICENSE
Answer questions 1-20 below, and SIGN the application on page 2 (No. 24).
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RETURN APPLICATION AND PAYMENT TO:
ORIGINAL APPLICATION FEES
Non-refundable application fee. . . . . . . . . . .
$ 25
BUREAU OF CONSUMER AND FACILITY SERVICES
Three-year license fee . . . . . . . . . . . . . . . . . .
$150
PO Box 2700-ESP
Total amount due. . . . . . . . . . . . . . . . . . . . . .
$175
Albany NY 12220-0700
Each fee must be paid with a separate check or money order
Telephone (518) 474-7998
payable to the Commissioner of Motor Vehicles.
Please Print or Type in the spaces next to the arrows.
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o
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Check type of application:
ORIGINAL
AMENDMENT (No Fee)
REPLACEMENT (No Fee)
Have you ever been a Certified Motor Vehicle Inspector and/or a Licensed Body Damage Estimator?
o
o
2ç
Yes
No
Expiration
If “YES”, give your Certification/License No. _________________________________________
Date____________________
LAST NAME
FIRST
M.I.
DATE OF BIRTH
M
F
Month
Day
Year
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4ç
5ç
/
/
MAILING ADDRESS NUMBER
APT. NO.
HEIGHT
EYE COLOR
(include street no., rural delivery, and/or box no.)
Feet
Inches
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7ç
8ç
MAILING ADDRESS STREET NAME
HOME TELEPHONE NUMBER
(include area code)
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9ç
(
)
CITY OR TOWN
STATE
ZIP CODE
COUNTY
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HOME ADDRESS
CITY
STATE
ZIP CODE
(if different from mailing address)
NUMBER AND STREET (include rural delivery, box no. and/or apartment no.)
13ç
o
o
14ç
Has your address changed since your last driver license was issued?
Yes
No
o
CLIENT I.D. NUMBER
(from NewYork State driver license or non-driver ID)
Check this box if you do not currently have a New York State
NOTE: Failure to provide a valid Client ID will prevent issuance
driver license or non-driver ID. A form (ID-5 VSBDE) will be
of a Body Damage Estimator License.
mailed with instructions on how to obtain a Client ID.
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PLEASE CONTINUE, AND SIGN ON PAGE 2
*VS-117*
PAGE 1 OF 2
VS-117 (10/15)
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