3d ID (M) FSGA / HAAF

Transcription

1 3d ID (M) FSGA / HAAF Vehicle Pre-Registration Packet for Contractors Items required to complete this packet are Valid: Drivers License / Proof of Insurance / Vehicle Registration Special Power of Attorney IF you wish to register a vehicle and your name does not appear on the vehicle registration. ENCLOSURE 3 AS OF: 13 JUN 01

2 Personal Information SSN LAST NAME FIRST NAME M. I. CATEGORY (See Instructions) DRIVERS LICENSE NUMBER BIRTHDATE INSTALLATION DRIVERS LICENSE STATE GENDER HT WT MARITAL STATUS - OPTIONAL FIELD EYE COLOR HAIR COLOR RACE- OPTIONAL FIELD Home Address ADDRESS ADDRESS CONT CITY STATE ZIP PHONE Page 1

3 Vehicle Information VIN YYYY VEHICLE YEAR REGISTRATION DATE VEHICLE MAKE VEHICLE MODEL VEHICLE COLOR VEHICLE LICENSE NUMBER VEHICLE BODY STYLE (See Instructions) VEHICLE LICENSE STATE YYYY VEHICLE LICENSE YEAR SIGNATURE DATE Vehicle Insurance Information INSURANCE COMPANY NAME INSURANCE EXP DATE INSURANCE POLICY NUMBER Page 2

4 REQUIRED SIGNATURES FOR VEHICLE REGISTRATION Privacy act of 1974 (5 U.S.C. 552a) AUTHORITY: Section 301 Title 5 U.S.C. PRINCIPAL PURPOSE(S): To obtain valid vehicle registration information. ROUTINE USES: To obtain vehicle registration MANDATORY OR VOLUNTARY DISCLOSURE AND EFFECT ON INDIVIDUAL NOT PROVIDING INFORMATION: Voluntary. If service member / family member / DOD Civilian / Retiree / Installation Patron does not provide information required by completion of the form, no vehicle registration decal will be issued. I verify that all information provided is accurate. Signature Date Printed Name INSTRUCTIONS TO REGISTRANT Information contained in this Vehicle Registration Packet should be updated as changes occur. The operation of a POC on a military installation is a privilege extended by the Installation Commander subject to compliance with appropriate State Laws pertaining to financial responsibility, safety inspections and registration; to conditions established in paragraph 2-1, ARE and AR ; and other appropriate regulations. Failure to comply with such laws and regulations may result in the administrative suspension or revocation of driving privileges or termination of installation registration. The registrant must remove the registration decal from the registered vehicle upon ETS (unless also a dependant), termination of employment, or sale of the POV. I have read / understand and will comply with the above statement. Signature Date Printed Name Page 3

5 INSTRUCTIONS Personal Information CATEGORY Information Only one of the following selections is valid for entry into this category: Civilian Contractor Dept. of HLTH / Human services ETS Family Family Retired Dependant Foreign Military Government Civ NAF National Guard PCS United Arab Emirate US Army US Army RET USAF USAF RET USAFR USAR USCG USCG RET USMC USMC / RET USN USN / RET USNG USNR Vendor Eye Color Black Blue Blue/Green Brown Gray Green Hazel Violet Hair Color Bald Black Blonde Brown Gray Lt Brown Red Marital Status Divorced Married Separated Single Widowed Widower Race Asian Pacific/Pacific Islander Black Hispanic Native American/American Indian Not Applicable Other Race is known but not listed Race White Vehicle Information Vehicle Body Style Only one of the following selections is valid for entry into this category: 2 ½ Ton Truck ATV Bus Camper Caravan Commercial Truck Convertible Coupe Crane Dump truck Hatchback HMWWV MACK Motor home Motorcycle Motorized Bicycle Peterbuilt Pick Up Truck Rec. Veh Sedan 2 Door Sedan 4 Door Sport Utility (SUV) Station Wagon Tractor Trailer Trailer Utility Vehicle Van Page 4

6 INSTRUCTIONS Upon receipt of the DD2220 / Expiration decal / Post Identifier / SR Grade Identifier, personnel must affix the decals promptly. No other decals will be located above DD2220. Decals will be applied in accordance with the below diagram: Motor Vehicle SR Grade if applicable DD2220 # # # Post Identifier Expiration Date Decal placed at the Top / Center of the front windshield. Decal must not be obstructed by accessories. Failure to place the decal in accordance with these guidelines will result in delayed / denied entry to the installation. Motorcycle Ft. Stewart # # # HAAF Motorcycle registration decal location. Locate decal on Left Front fork. Decal must not be obstructed by accessories. Decal must be placed facing forward for ease of viewing. * Failure to place the decal on the Front Left fork, and in a location to ease viewing will result in delayed / denied entry to the installation. Page 5