Next Of Kin Emergency Contact Enrollment
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Next Of Kin Emergency Contact Enrollment Form. This is a Ohio form and can be use in Bureau Of Motor Vehicles Statewide.
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Tags: Next Of Kin Emergency Contact Enrollment, BMV 2437, Ohio Statewide, Bureau Of Motor Vehicles
OHIO DEPARTMENT OF PUBLIC SAFETY
NEXT OF KIN/EMERGENCY CONTACT ENROLLMENT
To register, please visit our Web site at www.ohiobmv.com or complete this form and return it to your local
Deputy Registrar or mail it to:
Bureau of Motor Vehicles
Verification Services, Document Management
P.O. Box 16520
Columbus, Ohio 43216-6520
NOTE: If this form is not filled out completely, Next of Kin information will not be updated nor will this form be returned for
correction. Any changes to this document will override any previous submissions to add or change the Next of Kin
Notification information. Please ensure the accuracy of any Next of Kin information provided and ensure that this information
is updated as applicable; the BMV is not responsible for any errors in information provided or for failure to provide updated
information. Pursuant to Ohio Revised Code (R.C.) Section 4501.81, the BMV will not be liable if contact cannot be made
with a designated contact person in the event of an emergency.
1. PLEASE CHECK ONE OF THE FOLLOWING
Yes, I want to add Next of Kin/Emergency Contact information to my Ohio Driver License or Identification Card record.
Please remove all Next of Kin/Emergency Contact information listed on my Ohio Driver License or Identification Card
record (disregard section 3)
Please change the Next of Kin/Emergency Contact information on my Ohio Driver License or Identification Card
record to the following.
2. OHIO DRIVER LICENSE/IDENTIFICATION CARD HOLDER INFORMATION (Required)
OHIO APPLICANT LAST NAME
FIRST NAME
ADDRESS
MI
CITY
STATE
ZIP CODE
OHIO DRIVER LICENSE # OR IDENTIFICATION CARD # (Required)
3. NEXT OF KIN/EMERGENCY CONTACT INFORMATION *At least one phone number or address is required.
Contact #1 (Required)
LAST NAME
RELATIONSHIP
FIRST NAME
HOME PHONE*
ADDRESS
MI
CELL PHONE*
WORK PHONE*
EXT.
STATE
CITY
ZIP CODE
Contact #2 (Optional)
LAST NAME
RELATIONSHIP
FIRST NAME
HOME PHONE*
MI
CELL PHONE*
WORK PHONE*
EXT.
ADDRESS
CITY
STATE
ZIP CODE
4. SIGNATURE OF OHIO DRIVER LICENSE/IDENTIFICATION CARD HOLDER (Required)
SIGNATURE
DATE
X
BMV 2437 7/11
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