Form MC132M "Request for Voluntary Termination of Motor Carrier Permit Certificate of Self Insurance" - California

What Is Form MC132M?

This is a legal form that was released by the California Department of Motor Vehicles - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2015;
  • The latest edition provided by the California Department of Motor Vehicles;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form MC132M by clicking the link below or browse more documents and templates provided by the California Department of Motor Vehicles.

ADVERTISEMENT
ADVERTISEMENT

Download Form MC132M "Request for Voluntary Termination of Motor Carrier Permit Certificate of Self Insurance" - California

Download PDF

Fill PDF online

Rate (4.4 / 5) 11 votes
Page background image
Registration Operations Division
STATE OF CALIFORNIA
P.O. Box 932370 MS H875
Sacramento, CA 94232-3700
DEPARTMENT OF MOTOR VEHICLES
®
A Public Service Agency
(916) 657-8153
Request foR VoluntaRy teRmination of
motoR CaRRieR PeRmit
CeRtifiCate of self insuRanCe
MOtOR CARRiER nAME
CA nuMBER
BuSinESS ADDRESS
City
StAtE
ZiP CODE
MAiling ADDRESS (if different than business address)
City
StAtE
ZiP CODE
BuSinESS tElEPHOnE nuMBER
The above motor carrier requests to voluntarily terminate their self-insurance method for compliance with the proof of financial
responsibility requirement for the Motor Carrier Permit Program pursuant to California Vehicle Code (CVC) Section 34630.
the termination is effective
/
/
.
MOntH
DAy
yEAR
The above motor carrier understands that this self-insurance method of compliance with the proof of financial responsibility
requirement pursuant to CVC Section 34630 may be reinstated at any time upon filing a new Motor Carrier Permit Application
for Certificate of Self-Insurance form (MC 130 M) and an Assignment for a Motor Carrier Permit Certificate of Self Insurance
form (MC 133 M).
if the assigned deposit was released to the above listed motor carrier, submission of a deposit(s) in the appropriate amount(s)
pursuant to CVC Section 34631.5, subdivision (a), paragraphs (1) and (2) is required.
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and
correct.
PRintED nAME
titlE
SignAtuRE
DAtE
X
Print
Clear Form
MC 132 M (REV. 12/2015) WWW
Registration Operations Division
STATE OF CALIFORNIA
P.O. Box 932370 MS H875
Sacramento, CA 94232-3700
DEPARTMENT OF MOTOR VEHICLES
®
A Public Service Agency
(916) 657-8153
Request foR VoluntaRy teRmination of
motoR CaRRieR PeRmit
CeRtifiCate of self insuRanCe
MOtOR CARRiER nAME
CA nuMBER
BuSinESS ADDRESS
City
StAtE
ZiP CODE
MAiling ADDRESS (if different than business address)
City
StAtE
ZiP CODE
BuSinESS tElEPHOnE nuMBER
The above motor carrier requests to voluntarily terminate their self-insurance method for compliance with the proof of financial
responsibility requirement for the Motor Carrier Permit Program pursuant to California Vehicle Code (CVC) Section 34630.
the termination is effective
/
/
.
MOntH
DAy
yEAR
The above motor carrier understands that this self-insurance method of compliance with the proof of financial responsibility
requirement pursuant to CVC Section 34630 may be reinstated at any time upon filing a new Motor Carrier Permit Application
for Certificate of Self-Insurance form (MC 130 M) and an Assignment for a Motor Carrier Permit Certificate of Self Insurance
form (MC 133 M).
if the assigned deposit was released to the above listed motor carrier, submission of a deposit(s) in the appropriate amount(s)
pursuant to CVC Section 34631.5, subdivision (a), paragraphs (1) and (2) is required.
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and
correct.
PRintED nAME
titlE
SignAtuRE
DAtE
X
Print
Clear Form
MC 132 M (REV. 12/2015) WWW