Transcription of MANDATORY INSURANCE AND FINANCIAL RESPONSIBILITY …
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MANDATORY INSURANCE AND FINANCIAL RESPONSIBILITY …
ALL date fields require STATE OF alaska - DIVISION OF MOTOR VEHICLES. Month / Day / Year. certificate OF INSURANCE . Example: 11/4/11 LAW ENFORCEMENT INCIDENT NUMBER: CRASH. INFORMATION Date of Crash: City Where Crash Occurred: Driver Name: _____ Date of Birth: _____ License #: _____ State: _____. DRIVER Mailing Address: _____. Street or Box City State Zip Daytime Telephone: E-mail: Driver OWNER Name: _____ Date of Birth: _____ License #: _____ State: _____. OF. Mailing Address: _____. VEHICLE Street or Box City State Zip Year: Make: Model: License Plate #: VIN: VEHICLE. Did you have an automobile liability policy in effect covering this crash? YES NO Policy Number: Name & Address of INSURANCE Agent: Phone Number of INSURANCE Agent: Name of INSURANCE Company: Policy Period: Starting & Ending Dates To Your Signature: Sign your form after printing.
Form 466 (Rev. 03/2011) Alaska.gov/dmv E-mail: DOA.DMV.JDS@Alaska.gov STATE OF ALASKA - DIVISION OF MOTOR VEHICLES CERTIFICATE OF INSURANCE LAW …
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