Form DL 569 Virginia

Emergency Contact Application

Use this form to add, change or delete emergency contact information on your driver's license or identification card record. This information is only accessible to DMV and law enforcement.

This document is an emergency contact application form for Virginia DMV. It allows individuals with a learner's permit, temporary driver's license, driver's license, commercial driver's license, or identification card to add, change, or delete emergency contact information. Participation is voluntary and can be done online or by submitting the form to any DMV customer service center or mailing it to the Data Integrity Work Center. The applicant must provide full name, telephone number, DMV customer number, contact first name, last name, primary telephone number, contact street address, city, state, zip code, country, and relationship status with the contact. Each contact can have a request type of 'add info', 'change info', or 'delete emergency contact information'. The applicant must certify that they have notified their contacts of this designation and that all information is true and correct. Each contact's information will overwrite any existing emergency contact information on the record.