Notice of Collection of Personal Information - Applicants for Payment under Section 4

This form is required to explain to applicants the use of information that they provide to the Fund in order to assess and administer payment out of the Motor Vehicle Accident Claims Fund.

Need help downloading or filling forms?

Please check our Help page for solutions to common issues.

Alert!

PDF Forms will no longer work with older versions of Adobe Reader including Adobe Reader XI. Please update your free Adobe Reader to the latest version from the Acrobat Reader download page so that you can continue to access these forms.


Download Adobe Reader Free Version

Make the most of your experience with accessing, downloading, and filling forms acquired from the Central Forms Repository by watching this brief video overview.

single frame of the linked video. Click to begin playback in a new browser window
Download English Transcript

Forms, Links, and Information

Additional Information

Form Number 007-11392
Title Notice of Collection of Personal Information - Applicants for Payment under Section 4
Description This form is required to explain to applicants the use of information that they provide to the Fund in order to assess and administer payment out of the Motor Vehicle Accident Claims Fund.