Fillable Form DL-503 Request for Driver Information

What is the Pennsylvania Request for Driver Information form?

Form DL-503 or the Pennsylvania Request for Driver Information form is a request form to have a complete overview of a driver’s license holder’s driving record or history in Pennsylvania.

Form DL-503 can be used from the following:

• Driving record
• Employment
• Application for insurance
• Application for business credit
• During court order
• Credit potential investor, server, or current insurer.

You can request a driving record for yourself or for others with authorization.

How to fill out the Pennsylvania Request for Driver Information form?

You can print or type all the requested information in this form. Note that providing only a name and address does not supply adequate information on the driver’s documents.

RECORD PERIOD AND FILES

• Basic information
• (3) Three-year driver record
• (10) Ten-year driver record
• Full history
• Certified driver record
• Copy of document from file (microfilm)
• Certified copy of document from file

A. REQUEST INFORMATION

NAME/COMPANY

Enter the requester’s full name or the company name.

ADDRESS

Enter the complete office address of the requester starting with street number and street name.

Note: P.O will be only used as an addition to the actual address, but is not acceptable to use as the main address.

CITY

Enter the city.

STATE

Enter the state.

ZIP CODE

Enter the ZIP code.

DAYTIME TELEPHONE NUMBER

Enter your active telephone number including the area code.

RELATIONSHIP TO THE DRIVER

Indicate your relationship to the driver.

SIGNATURE

Sign to confirm the information you entered.

Note: Notarization is not necessary if you are requesting for your own record. You must complete sections A and C only.

B. END USER OF INFORMATION BEING REQUESTED

NAME/COMPANY

Enter the end user’s full name or company name.

ADDRESS

Enter the end user’s complete address of the requester starting in street number and street name.

Note: P.O will be only used as an addition to the actual address, but is not acceptable to use as the main address.

CITY

Enter the city.

STATE

Enter the state.

ZIP CODE

Enter the ZIP code.

DAYTIME TELEPHONE NUMBER

Enter your active telephone number including the area code.

RELATIONSHIP TO THE DRIVER

Indicate your relationship to the driver.

SIGNATURE

Sign to confirm the information you entered.

C. DRIVER INFORMATION

NAME

Provide the driver’s name in this format: last name, first name, middle initial

ADDRESS

Enter the driver’s complete address starting with street number and street name.

CITY

Enter the city.

STATE

Enter the state

ZIP CODE

Enter the ZIP code.

PHONE NUMBER

Enter the driver’s telephone number.

DATE OF BIRTH

Enter the driver’s birthdate in this format: mm/dd/yyyy

DRIVER NUMBER

Indicate the driver’s registered license number. This will help pull up his driving record.

Note: Complete sections A, C, and D if you are requesting a record other than your own. Section E must have the driver’s signature if block B, E, or L is marked in section D. If the requester is acquiring the information on behalf of someone else and then section B must also be completed.

D. AFFIDAVIT OF INTENDED USE

Select one of your intended purpose from the following:

• Driver Release
• Credit Business
• Credit Potential Investor, Server, or Current Insurer
• Employment
• Insurance Company
• Court Order
• Attorney

E. DRIVER RELEASE

This section gives the driver’s consent to retrieve his or her driving record from the Department of Transportation in Pennsylvania.

Enter the driver’s full name. Then, enter the requester’s name or company name.

Enter the driver’s signature and date this application.

F. MICROFILM

TYPE OF DOCUMENT

Input the type of document you are applying for microfilm. Here is the list of available documents:

• Citations
• Ignition Interlock Removal Letter
• Court Certifications
• Suspension/Revocation Letters
• Applications
• Restoration Letters
• License Renewals Rescind Letters
• Judgments
• Department Hearing or Exam Notice
• Suspension Credit Affidavits

You must specify the type of document and date of violation for a microfilm request. Several citations on the record will cost $10 each.

SIGNATURE

Read the disclosure statements that the driver record request will use upon the intended purpose for this petition only. False information is punishable under the penalties of 18 Pa C.S. Section 4903(a)(2). If you acknowledge, supply the requester’s full name and signature.

NOTARIZATION

Visit the nearest notary office to notarize the Pennsylvania Request for Driver Information form.

PAYMENT

Payment for each request is non-refundable. A fee will still be applied as the cost of the search if the bureau has no record for the requested information or the data supplied is insufficient.

Make sure that you have marked the type of record requested in this form and make a check or money order payable to PennDOT.

Where to submit the Pennsylvania Request for Driver Information form?

Bureau of Driver Licensing

Driver Record Services

P.O. Box 68695

Harrisburg, Pennsylvania 17106-8695

For overnight and other special mail, you may send it at:

Bureau of Driver Licensing

Driver Record Services

1101 South Front Street, 3rd floor

Harrisburg, Pennsylvania 17104-2516

What do I need to know?

• A driver record should be kept confidential. The requester or the end-user is responsible for protecting the confidentiality of the driver record and liable for legal actions.

• A driver record information cannot be sold, assigned, or otherwise transferred to any party, other than the end-user.

• The PennDOT retains all the exclusive entitlement of driver record information. Thus, the information should not be combined or link in with any other data on any third party as a database unless required by law.

• The driver record information cannot be used for direct mail advertising or any other type or types of mail or mailings.

• Dissemination or publication of a driver record information on the internet on purpose is not allowed without written consent from PennDOT.

• PennDOT has the authority to inspect each Request for Driver Information. Access to Pennsylvania driver record information will be denied, once the requester or end-user found to have requested driving records unauthorized by the driver.