Ae Form 190-1t - Application For U.s. Forces Pov Certificate Of License And Allied Transactions

APPLICATION FOR U.S. FORCES POV CERTIFICATE OF LICENSE AND ALLIED TRANSACTIONS

(AE Reg 190-1/USNAVEUR Inst 11240.6T/USAFE Inst 31-202)

DATA REQUIRED BY THE PRIVACY ACT OF 1974

AUTHORITY: Article 9, Supplementary Agreement to NATO SOFA; 10 USC 3012.

PRINCIPAL PURPOSE(S): To evaluate an application for a U.S. Forces privately owned vehicle (POV) certificate of license and to issue a license on establishment of eligibility.

ROUTINE USE(S): a. To verify the licensed status of individuals to both U.S. and foreign law-enforcement, investigative, and administrative authorities, to attorneys representing

clients, and to insurance companies.

b. To record elements of an individual’s driving history (e.g., to record suspension or revocation of license or declaration of ineligibility for a license) and, when warranted, to

take or recommend appropriate action.

c. For internal locator purposes within the USAREUR Motor Vehicle Registry.

d. To support requests for miscellaneous services submitted by individuals to the USAREUR Motor Vehicle Registry.

e. See routine uses set forth in 40 Federal Register 35151.

MANDATORY OR VOLUNTARY DISCLOSURE AND EFFECT ON INDIVIDUAL NOT PROVIDING INFORMATION The disclosure of personal information, including social security

number (SSN), is mandatory to obtain a license. Failure to provide any item of the information will result in rejection of the application. Rejection for this reason is necessary

since names do not provide an individual with a unique identification.

License number

Effective date

Expiration date

Codes

COMPLETED BY REGISTRY PERSONNEL ONLY

1. Applicant’s rank/grade 2. Applicant’s name

(Last, first, MI)

3. Date of birth

4. Place of birth

(City/State/Country)

5. Applicant’s SSN

6. U.S. driver’s license number

7. German, EU, or NATO license no.

8. Sex

Male

Female

9. Applicant’s military mailing address (unit no., box no., and APO no.)

10. Organ donor

11. Corrective lenses

Yes

No

Yes

No

12. Sponsor’s SSN

13. Sponsor’s name

(Last, first, MI)

14. Sponsor’s telephone number

15. Sponsor’s

(DSN)

rank/grade

16. Sponsor’s military mailing address (unit no., box no., and APO no.)

17. Sponsor’s branch of service

Army

AF

Navy

Marine

Military

Civilian

18. Type of application

19. Class of license

20. Restrictions

21. Examiner statement

Initial

1

250 CC+

Letter

I have examined the applicant IAW AE

Replacement

1a

80-250 CC

Medical

Reg 190-1/USNAVEUR Inst

Addition of class

1b

less than 80 CC & less than 80 kph

Auto trans only

11240.6T/USAFE Inst 31-202. The

STATION/STAMP

applicant has satisfactorily passed all

Renewal

2

Truck

Daylight only

required tests.

Reinstatement

2

Bus

Changes

#Passengers

21. Examiner’s signature

Date

EU or NATO transfer

3

Auto

Restriction

4

less than 50 CC & up to 50 kph

German transfer

5

less than 50 CC & up to 25 kph

PAID STAMP

22. Applicant statement

I am familiar with the provisions of the directives cited above and am qualified for a U.S. Forces POV certificate of

license. I am aware that any false or misleading information submitted by me may subject me to administrative

and/or disciplinary action. I am familiar with the implied consent provisions of the directives cited above and

understand that my U.S. Forces POV certificate of license will be revoked if I refuse to submit to a blood-alcohol

test at the request of U.S. military or security police or Navy shore patrol or German police who suspect me to be

operating a vehicle while my ability to do so is impaired by alcoholic beverages.

Applicant’s signature and date

INSTRUCTIONS FOR AE FORM 190-1T

23. Test scores and dates for driver testing only

24.

Block 5.

Enter applicant’s social security number (SSN);

Have you ever been convicted or have/

if no SSN, use passport no., ID card no., or

had a driver’s license suspended/revoked for

Military license number

sponsor’s SSN.

driving under the influence of alcohol

Block 6.

Enter state and stateside license number; if

Date of orientation

(DUI/DWI) or refusing to consent to a BAC?

none or not available, enter N/A.

Written test score

If yes, where and when?

Block 7.

Enter German, EU, or NATO license number

to be exempted from the road test.

Failed version

Failed version

Yes

No

Mark “yes” if you wish to be an organ donor;

Block 10.

Eye test

mark “no” if you do not.

Block 11.

Mark the appropriate box to indicate whether

Where:

Failed version

or not you wear glasses or contact lenses.

To be completed by all applicants, even if the

Motorcycle written test score

When:

Block 12-17.

applicant is the sponsor.

Motorcycle proficiency test score

Block 15.

Enter military sponsor's rank (e.g., SPC, SGT,

Applicant’s signature

MAJ, GS-9), not pay grade.

Motorcycle Safety Foundation Card date issued

Block 18-21.

Mark appropriate blocks.

Air Force motorcycle course date taken

Block 22 & 24.

Sign and date.

Vers. 01.00

Page 1 of 1

AE FORM 190-1T, AUG 08

Previous editions are obsolete.