NATIONAL DRIVER REGISTER FILE CHECK
DL 56 (10/10/2013)
INDIVIDUAL REQUEST
Purpose:
Use this form to request a National Driver Register (NDR) file check on yourself and obtain a copy of the record if
one exists.
Instructions:
Complete this form and submit it to your local DMV customer service center or mail it directly to NDR at the
address listed on the reverse side of this form. If you mail the form to NDR, it must be signed in the presence of
a notary public prior to mailing.
NOTE: Requests may not be made under any circumstances by or on behalf of any individual other than
the person on whom the information is being requested.
REQUESTER INFORMATION (type or print clearly)
FULL LEGAL NAME (first, middle, last)
OTHER NAMES USED (maiden, prior name, nickname, professional name, other)
STREET ADDRESS
HOME TELEPHONE (optional)
(
)
CITY, STATE, ZIP CODE
WORK TELEPHONE (optional)
(
)
DRIVER LICENSE NUMBER
ISSUING STATE
SOCIAL SECURITY NUMBER (optional)
BIRTH DATE (mm/dd/yyyy)
GENDER
EYE COLOR
HEIGHT
WEIGHT (lbs)
M
F
ft.
in.
REQUESTER CERTIFICATION
I certify and affirm that all information presented in this form is true and correct, that any documents I have presented to DMV are genuine, and that the
information included in all supporting documentation is true and accurate. I make this certification and affirmation under penalty of perjury and I understand that
knowingly making a false statement or representation on this form is a criminal violation.
REQUESTER SIGNATURE
DATE (mm/dd/yyyy)
NOTARIZATION (must be completed by notary public)
REQUIRED ONLY IF THIS FORM IS MAILED DIRECTLY TO NDR
NOTARY PUBLIC SEAL
Commonwealth of Virginia, city or county of _____________________________________ subscribed and
sworn before me on this _________________ day of __________________________________________
(MONTH)
(YEAR)
by___________________________________________________ in the city or county and state aforesaid.
REGISTRATION NUMBER (6 digits)
MY COMMISSION EXPIRES (mm/dd/yyyy)
NOTARY PUBLIC NAME
NOTARY PUBLIC SIGNATURE
DMV USE ONLY
Proof of Identification
Remarks/CSR Stamp
Two (2) proofs of identification required if requester submits this form in person to CSC.
□
Valid Out of State License Number ____________________________________________________
□
Birth Certificate Number _____________________________________________________________
□
Military Discharge Papers ID Number __________________________________________________
□
Passport Number __________________________________________________________________
□
US Immigration Resident Alien Number ________________________________________________
□
Other____________________________________________________________________________
□
Two Documents Witnessed by _______________________________________________________