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The MVA ICD 071 form plays a crucial role in Maryland's Vehicle Insurance Compliance Program. This form is used by vehicle owners to certify that their vehicle was not driven, involved in an accident, or cited during a period of insurance lapse. It requires detailed information, including the vehicle's identification number, tag number, and the owner's personal details, such as their driver's license number. The owner must provide a statement outlining the reasons for the insurance lapse and confirm that the information provided is accurate under penalty of perjury. Additionally, the form includes sections for witness statements, where individuals can affirm the owner's claims. These witnesses must also certify the truthfulness of the information presented. Proper completion of the MVA ICD 071 form is essential for compliance with Maryland vehicle laws, and it helps ensure that vehicle owners remain accountable for their insurance responsibilities. For any questions or assistance, the Maryland Motor Vehicle Administration provides resources and customer support to guide individuals through the process.

Mva Icd 071 Example

Motor Vehicle Administration

6601 Ritchie Highway, N.E.

Glen Burnie, Maryland 21062

ICD-071 (12-13)

Maryland Vehicle Insurance Compliance Program – Certified Statement

Section 1: Owner’s Information and Statement of Facts

CASE NUMBER

INSURANCE CANCELLATION DATE

INSURANCE COMPANY

TAG NUMBER

TITLE NUMBER

VEHICLE IDENTIFICATION NUMBER:

YEAR:

MAKE:

VEHICLE OWNER (First, Last Name):

OWNER’S DRIVERS LICENSE NUMBER:

The vehicle listed above has not been driven, involved in an accident, or issued a citation during period of insurance lapse

 

to

 

. During this time the vehicle was parked at

MM/DD/YY

 

MM/DD/YY

 

(Location)

(Street Address)

(CIty)

(State)

(Zip Code)

For the following reason(s):

(Supporting documentation attached)

I certify, under penalty of perjury, that the statements made above are true and correct to the best of my knowledge, information and belief, under Section 12-109 b (2) of the Maryland Vehicle Law.

Signature Owner/Co-Owner

Date

Daytime Telephone Number

Section 2: Witness Statement of Facts

Witness A or Repair Facility - Business License #

I certify, under penalty of perjury, that the statements made above by the vehicle owner are true and correct to the best of my knowledge, information and belief, under Section 12-109(b) of the Maryland Vehicle Law.

Signature Witness

Drivers License Number

Date

Daytime Phone Number

Witness B

I certify, under penalty of perjury, that the statements made above by the vehicle owner are true and correct to the best of my knowledge, information and belief, under Section 12-109(b) of the Maryland Vehicle Law.

 

Witness Signature

Drivers License Number

 

Date

 

Daytime Phone Number

 

 

 

 

 

 

 

 

 

MVA Use Only

 

 

 

 

 

 

 

 

Moving Violation/Accident

No q

Yes q

Date:_______________

Case/Ticket #:________________

 

 

Prior Case:

No q

Yes q

Date:_______________

Case #:______________________

 

 

Adjustment Approved:

No q

Yes q

Amount:_____________

 

 

 

Authorized By:_ ________________________________________

ID:_ _________________

Date:__________________

 

For more information, please call: 410-768-7000 (to speak with a customer agent).

TTY for the hearing impaired: 1-800-492-4575. Visit our website at: www.MVA.Maryland.gov

File Breakdown

Fact Name Description
Form Purpose The MVA ICD-071 form is used to certify compliance with Maryland's Vehicle Insurance Compliance Program. It helps vehicle owners declare that their vehicle has not been driven during an insurance lapse.
Governing Law This form is governed by Section 12-109(b) of the Maryland Vehicle Law, which outlines the requirements for vehicle insurance compliance.
Owner's Certification The vehicle owner must certify that the information provided is true and correct, under penalty of perjury. This includes details about the vehicle and the period of insurance lapse.
Witness Requirement The form requires signatures from witnesses or a repair facility to validate the owner's statements. Each witness must also certify the truth of the information provided.
Contact Information For assistance, individuals can contact the Maryland Motor Vehicle Administration at 410-768-7000 or visit their website at www.MVA.Maryland.gov.

Guide to Using Mva Icd 071

Completing the MVA ICD 071 form is an important step in addressing your vehicle's insurance compliance. After filling out this form, you will need to submit it to the appropriate authorities to ensure that your vehicle is in good standing. Below are the steps to guide you through the process of filling out the form.

  1. Begin with Section 1: Owner’s Information and Statement of Facts.
  2. Enter the CASE NUMBER at the top of the section.
  3. Provide the INSURANCE CANCELLATION DATE.
  4. Fill in the INSURANCE COMPANY name.
  5. Input the TAG NUMBER of your vehicle.
  6. Write down the TITLE NUMBER.
  7. Provide the VEHICLE IDENTIFICATION NUMBER (VIN).
  8. Enter the YEAR of the vehicle.
  9. Specify the MAKE of the vehicle.
  10. Fill in the VEHICLE OWNER name (First and Last).
  11. Input the OWNER’S DRIVERS LICENSE NUMBER.
  12. State that the vehicle has not been driven, involved in an accident, or received a citation during the insurance lapse period. Provide the start and end dates (MM/DD/YY).
  13. Indicate where the vehicle was parked by filling in the LOCATION (Street Address, City, State, Zip Code).
  14. List the reason(s) for the lapse in insurance and ensure you attach supporting documentation.
  15. Sign and date the form in the designated area, confirming the truthfulness of your statements.
  16. Provide your Daytime Telephone Number.

Next, move to Section 2: Witness Statement of Facts. Here, you will need to provide information from witnesses or a repair facility regarding the vehicle's status during the insurance lapse. Follow the steps outlined in this section to complete the form accurately.

  1. For Witness A or Repair Facility, provide the Business License #.
  2. Witness A must certify the statements made by the vehicle owner by signing and dating the form.
  3. Witness A should provide their Drivers License Number and Daytime Phone Number.
  4. If applicable, repeat the process for Witness B, ensuring they also sign, date, and provide their information.

After completing both sections, review the form for accuracy before submission. Make sure all required signatures are in place and any necessary documentation is attached. This will help facilitate a smooth review process by the authorities.

Get Answers on Mva Icd 071

What is the purpose of the MVA ICD-071 form?

The MVA ICD-071 form is used in Maryland as part of the Vehicle Insurance Compliance Program. It allows vehicle owners to certify that their vehicle was not driven, involved in an accident, or cited during a lapse in insurance coverage. By submitting this form, owners can provide a statement of facts regarding the vehicle's status during the insurance lapse period.

Who needs to fill out the MVA ICD-071 form?

This form must be completed by vehicle owners who have experienced a lapse in their vehicle insurance. If a vehicle owner has not driven their vehicle during this period, they should fill out the form to avoid penalties associated with uninsured vehicle operation. Additionally, witnesses, such as repair facilities or individuals who can confirm the vehicle's status, are also required to provide their statements.

What information is required on the MVA ICD-071 form?

When completing the MVA ICD-071 form, the following information is necessary:

  • Owner's full name and driver's license number
  • Vehicle identification number (VIN), tag number, and title number
  • Insurance cancellation date and insurance company name
  • Dates during which the vehicle was not driven
  • Location where the vehicle was parked
  • Reasons for the insurance lapse, along with supporting documentation

Witnesses must also provide their signatures and relevant identification details.

How do I submit the MVA ICD-071 form?

Once the MVA ICD-071 form is completed and signed, it should be submitted to the Maryland Motor Vehicle Administration (MVA). The form can be mailed to the MVA's address at 6601 Ritchie Highway, N.E., Glen Burnie, Maryland 21062. For any questions or additional assistance, individuals can call 410-768-7000 or visit the MVA website at www.MVA.Maryland.gov.

Common mistakes

Filling out the MVA ICD 071 form can be straightforward, but there are common mistakes that individuals often make. One frequent error is failing to provide complete information in the Owner’s Information section. Each field, including the vehicle identification number and the owner’s driver’s license number, must be filled out accurately. Incomplete or incorrect details can lead to delays or rejections of the application.

Another mistake involves the insurance cancellation date. It is essential to specify the correct date when the insurance was canceled. If this date is inaccurate, it may raise questions regarding the vehicle's insurance status during the specified period. This could complicate the verification process and lead to potential penalties.

People often overlook the importance of providing a valid reason for the insurance lapse. The form requires a clear explanation, and supporting documentation should be attached if applicable. A vague or insufficient reason may not satisfy the requirements, resulting in further inquiries from the Motor Vehicle Administration.

In Section 2, individuals sometimes forget to include all necessary signatures. Both witnesses must sign the form, and their driver’s license numbers should be provided. Missing signatures can invalidate the submission, causing delays in processing.

Another common issue is the failure to double-check the dates listed on the form. Dates should be accurate and consistent throughout the document. Any discrepancies can create confusion and may require additional clarification, which can prolong the process.

Finally, some individuals neglect to include their daytime telephone number. Providing a contact number is crucial, as it allows the MVA to reach the vehicle owner for any follow-up questions or clarifications. Without this information, communication may be hindered, complicating the resolution of the case.

Documents used along the form

The MVA ICD-071 form is an essential document for individuals participating in the Maryland Vehicle Insurance Compliance Program. It serves to certify that a vehicle was not driven during a period of insurance lapse. Several other forms and documents may accompany the MVA ICD-071 to provide additional information or fulfill related requirements. Below is a list of these documents, along with a brief description of each.

  • Vehicle Registration Application: This form is used to register a vehicle with the Maryland Motor Vehicle Administration. It collects information about the vehicle and its owner, ensuring that the vehicle is legally recognized for use on public roads.
  • Proof of Insurance: This document verifies that a vehicle is covered by an active insurance policy. It is essential to demonstrate compliance with Maryland's insurance requirements and must be submitted to the MVA.
  • Accident Report Form: If the vehicle was involved in an accident during the insurance lapse, this form must be completed. It provides details about the incident and may be required for insurance claims or legal purposes.
  • Statement of Facts: This document outlines the circumstances surrounding the vehicle's insurance lapse. It may include information about the owner's situation and any supporting evidence, helping to clarify the reasons for the lapse.
  • Witness Statement Form: If applicable, this form is completed by individuals who can corroborate the owner's claims regarding the vehicle's status during the insurance lapse. It adds credibility to the owner's statement and may assist in the compliance review process.

Each of these documents plays a crucial role in ensuring compliance with Maryland's vehicle insurance laws. They provide necessary information that can assist the MVA in processing the MVA ICD-071 form effectively. Ensuring all relevant documents are completed accurately will help facilitate a smoother resolution of any insurance compliance issues.

Similar forms

  • Affidavit of Non-Use: Similar to the MVA ICD 071 form, this document is used to declare that a vehicle has not been driven or used during a specific period. It requires the owner's information and a sworn statement, providing legal protection against penalties for insurance lapses.
  • Certificate of Insurance: This document proves that a vehicle is insured. Like the MVA ICD 071, it includes details about the vehicle and owner, ensuring compliance with state insurance laws.
  • Vehicle Registration Application: When registering a vehicle, this form collects similar information, such as the owner's details and vehicle identification number. Both documents are essential for maintaining legal vehicle status.
  • Notice of Cancellation: This form is issued by an insurance company when a policy is canceled. It parallels the MVA ICD 071 by documenting the lapse in coverage and the reasons behind it.
  • Proof of Residency: Often required for vehicle registration, this document verifies the owner's address. Like the MVA ICD 071, it helps establish the owner's identity and connection to the vehicle.
  • Traffic Accident Report: In cases of accidents, this report details the incident and involved parties. It shares similarities with the MVA ICD 071 by documenting facts and statements related to vehicle use.
  • Insurance Claim Form: When filing a claim for damages, this form requires information about the vehicle and the owner. It serves a similar purpose in documenting incidents related to vehicle insurance.
  • Vehicle Transfer Form: This document is used when ownership of a vehicle changes. It collects the same type of information as the MVA ICD 071, ensuring all parties are informed of the vehicle's status.

Dos and Don'ts

When filling out the MVA ICD 071 form, it’s essential to follow certain guidelines to ensure your submission is accurate and complete. Here’s a list of things you should and shouldn’t do:

  • Do read the entire form carefully before starting to fill it out.
  • Do provide accurate information about your vehicle, including the VIN and tag number.
  • Do ensure that all dates are correctly formatted and clearly written.
  • Do attach any required supporting documentation to substantiate your claims.
  • Do sign and date the form in the appropriate sections.
  • Don’t leave any sections blank; if something doesn’t apply, indicate that clearly.
  • Don’t use abbreviations or shorthand that might confuse the reviewer.
  • Don’t forget to include contact information in case the MVA needs to reach you.
  • Don’t submit the form without double-checking for errors or omissions.
  • Don’t ignore the instructions for the witness statements; they must be filled out correctly.

Following these guidelines can help streamline the process and avoid unnecessary delays. Take your time, and ensure that every detail is accurate before submitting your form.

Misconceptions

Understanding the MVA ICD 071 form is crucial for vehicle owners in Maryland, especially when dealing with insurance compliance issues. However, several misconceptions can cloud the clarity of this important document. Here are seven common misunderstandings:

  • It is only for accidents. Many believe the MVA ICD 071 form is only necessary if an accident occurs. In reality, this form is used to certify the status of a vehicle during a lapse in insurance, regardless of whether an accident took place.
  • It can be submitted without supporting documents. Some think they can submit the form without any additional paperwork. However, supporting documentation is essential to validate the statements made in the form, particularly regarding the reasons for the insurance lapse.
  • Only the vehicle owner can fill it out. While the vehicle owner must sign the form, others, such as witnesses or repair facilities, can also provide statements. Their signatures add credibility to the claims made in the document.
  • It is a one-time requirement. Many assume that once they submit the form, they won’t need to address insurance compliance again. However, if a vehicle is uninsured for any period in the future, the form may need to be submitted again.
  • Filling it out is a simple process. Some individuals think the form is straightforward and easy to complete. In truth, it requires careful attention to detail and accuracy, as any mistakes can lead to complications or penalties.
  • It is not legally binding. A common misconception is that signing the form has no legal consequences. On the contrary, certifying false information can result in serious legal repercussions, including penalties for perjury.
  • It does not affect vehicle registration. Many believe that submitting the MVA ICD 071 form has no bearing on their vehicle registration status. However, failing to comply with insurance requirements can lead to registration issues, including potential fines or suspension.

By dispelling these misconceptions, vehicle owners can better navigate the complexities of the MVA ICD 071 form and ensure they remain compliant with Maryland's vehicle insurance laws.

Key takeaways

When filling out and using the MVA ICD 071 form, keep these key takeaways in mind:

  • Accurate Information is Crucial: Ensure all details about the vehicle, owner, and insurance are correct. Mistakes can lead to delays or complications.
  • Documentation is Required: Attach supporting documents that justify the reason for the insurance lapse. This can include repair bills or proof of inactivity.
  • Witness Statements: Obtain signatures from witnesses or repair facilities. Their certification adds credibility to your claims regarding the vehicle's status.
  • Signature and Date: The form must be signed and dated by the vehicle owner. This step is essential for the certification to be valid.
  • Contact Information: Provide a daytime telephone number. This allows the MVA to reach you if they need further information.
  • Follow Up: After submission, keep track of your case. You may need to provide additional information or clarification.

By adhering to these guidelines, you can navigate the process more smoothly and effectively.