VEHICLE REGISTRATION REQUEST
For use of this form, see XVIII Airborne Corps and Fort Bragg Reg 190-5; the proponent agency is PSBC.
PRIVACY ACT STATEMENT
AUTHORITY: Title 5, U.S.C. Section 301.
PRINCIPAL PURPOSE: To provide information on individuals requesting authority to register a vehicle.
ROUTINE USES: Military Police records check.
DISCLOSURE: Voluntary. However, authority to register a vehicle will be withheld form individuals who do not provide information.
SECTION A - APPLICANT INFORMATION (must be completed for all applicants)
Last Name First Name MI Sex SSN
Date of Birth Race
Asian/Pacific Islander Operator's License Number
Operator's License State
Day Month Year Black
Am. Indian/Alaskan Nat.
Complete either Section B (left side) or Section C (right side) below - whichever is applicable - but not both.
(If registering two vehicles, and one is a "Section B" type and the other is a "Section C" type, use a separate form for each.)
SECTION B - CONTRACTOR INFORMATION SECTION C - SPONSOR INFORMATION
Use for Privately Owned Vehicle (POV) registration for contractors Use for all commercial vehicles, vendor POVs,
(and for activities processed like contractors). and other personnel covered under para 3-3b, FB Reg 190-5.
This request may cover more than one vehicle. This request may cover only one vehicle.
Prime Contractor Company Name Sponored Company/Agency/Contractor Affiliation (If applicable)
Subcontractor Company Name (If applicable) Nature of Business
Normal Daily Duty Location on Fort Bragg (Bldg Number, Construction Site
SECTION D - CONTRACTOR OR SPONSOR CERTIFICATON (must be completed for all applicants)
Expected Dates of Employment/Services to Be Provided
Day Month Year Day Month Year
I have a DA Form 1687 on file at the Randolph Street Vehicle Registration Center. A completed copy of FB Form 2229-E for
the applicant is attached. If for contractor employee POV (Section B), I certify employment for this person. If not already
provided to the Main Vehicle Registration Center, a copy of those pages of the contract showing contract number, length
(start/end dates), and performance location (Fort Bragg) is attached. If for other individual POV and/or commercial vehicle
(Section C), I certify that I am the sponsor for this person and vehicle and accept full responsibility.
Printed/Typed Name of Individual Certifying Employment, or Sponsor Position
Phone Number Complete E-Mail Address
Signature (Must be original; use colored ink - red, blue, etc.) Date
SECTION E - APPLICANT CONSENT TO CRIMINAL HISTORY CHECK (must be completed for all applicants)
I consent to a Criminal History Check through the Division of Criminal Information (DCI), National Crime Information Center
(NCIC), and/or other appropriate systems/media. I understand that registration may be denied or rescinded based on
unfavorable results of the check. I understand I must visit the Randolph Street Vehicle Registration Center (Bldg 8-1078) to
apply for the registration associated with this application.
Signature of Applicant (Must be original; use colored ink - red, blue, etc.) Date
DCI/NCIC Check Significant Derogatory Info Found Adjudicated By Date
FB FORM 5051-E, APR 2004