Form PS35016 template
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Insurance Certification Form
Minnesota law mandates that before reinstatement of revoked driving privileges or registration for no insurance, an operator must file a certificate of insurance with the Commissioner of Public Safety. This can be fulfilled by being named as a driver on an existing policy or purchasing a non-owner's or operator's policy. The certificate should be mailed to or faxed to Driver and Vehicle Services and must be maintained for one calendar year. The form requires the driver's name, DL number, date of birth, insurance company signature, company name, vehicle description (year, identification number, plate number, effective date, make, policy number), and is to be completed by an authorized representative of the insurance company, not the agent.
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