Virginia DL 569 Emergency Contact Application (Fillable PDF)

The DL 569 is the Virginia Department of Motor Vehicles (DMV) Emergency Contact Application. It lets you add, change, or delete emergency contact information linked to your driver’s license or state ID. Keeping this information up‑to‑date can help law enforcement and DMV staff reach your designated contacts quickly in an emergency.

What Is the DL 569 Form?

This form is a short, printable PDF that captures:

• Primary and secondary emergency contacts
• Relationship to you
• Phone numbers and mailing address
• Signature and date

Because it’s a fillable PDF, you can complete it directly in your browser without needing special software.

How to Fill Out the DL 569 Online

Instead of downloading the PDF and opening a separate editor, simply click the “Fill out this form” button on this page. The Formize PDF Filler will load instantly, allowing you to type, select, and sign the form online.

1. Click Fill out this form below.
2. The Formize PDF Filler app opens in a new tab.
3. Enter each field carefully – the form will highlight required sections.
4. Save your progress at any time with the Save button.
5. When finished, click Submit to download the completed PDF.

Common Mistakes to Avoid

• Leaving a required field blank – the filler will block submission.
• Entering an incorrect phone format (use 10‑digit numbers without dashes).
• Forgetting to sign and date the form.
• Using a non‑Virginia address for a Virginia driver’s license.

Where to Submit Your Completed Form

After you download the completed PDF, you can:

• Mail it to your local Virginia DMV office.
• Drop it off in person at any DMV service center.
• Upload it via the Virginia DMV online portal if you have an account.

Make sure to keep a copy for your records.