Form DS-102 APPLICATION FOR TITLE

U.S. Department of State

OFFICE OF FOREIGN MISSIONS
DIPLOMATIC MOTOR VEHICLE OFFICE

OMB Approval No. 1405-0105
Expires XX-XX-20XX
*Estimated burden 15 minutes

APPLICATION FOR TITLE
SEE INSTRUCTIONS ON REVERSE
ATTENTION: Application cannot be processed without completion of gray shaded areas.
Country
Mission Type (Embassy, Consulate, UN, OAS, Other)
Title to:
Self/Terminating

Sell

I.D. Number

Transfer to Another
Diplomat/Employee

Export

Owner Name (Surname)

(First)

Date of Birth (mm-dd-yyyy)

(MI.)

Visa

Principal
Dependent

Address (Number, Street, Apartment, City, State, Zip Code)
Co-owner Name (Surname)

I.D. Number

Vehicle Identification Number
Body

Year

Weight

FOR OFFICE USE ONLY
Do Not Write
in this space
LR
P

(First)

Date of Birth (mm-dd-yyyy)

License Plate Number

(MI.)

Visa

Principal

Make

Dependent
Model

Odometer

Color

Lien Holder/Legal Owner (Name in Full) If the registered owner is the legal owner, write NONE.

T Number

Title Moved to
Name

I.D.Number

Address
Buyer Name (Surname)

(First)

(MI.)

Address (Number, Street, Apartment, City, State, Zip Code)
A. Buyer is an official representative of:
(Country)

Tag Number

(Mission Type)
Expiration Date (mm-dd-yyyy)

B. Buyer is not a foreign national acting as an official representative.
The undersigned certifies that, in accordance with the provisions of Title 18 U.S. Code, Section 1001,
prohibiting the making of false statements in connection with a federal matter, the information stated
here is true and correct.

Production Dates

THE OFFICIAL (DIPLOMATIC, CONSUL, STAFF) FEDERAL LICENSE PLATES ISSUED FOR THIS
VEHICLE WILL NOT BE REMOVED FROM THE VEHICLE UNTIL AUTHORIZED BY THE U.S.
DEPARTMENT OF STATE, OFFICE OF FOREIGN MISSIONS AND THE OFFICIAL FEDERAL LICENSE
PLATES WILL BE RETURNED TO THE OFFICE OF FOREIGN MISSIONS.
Owner's Signature
Date (mm-dd-yyyy)

(EMBASSY SEAL)

DS-102
011-2017

Co-owner's Signature

Date (mm-dd-yyyy)

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INSTRUCTIONS
1. To avoid delays in processing, please ensure the accuracy of the odometer reading and he vehicle identification number.
2. Always write your name in the following order: surname, given name, initial. Spell your name exactly as it was given to the Department of
State. (Applications with names different from the accreditation record will be returned for verification.)
3. When writing in numbers only, use the month, date, year format (mm-dd-yyyy). Give your date of birth exactly as it was given to the
Department of State.
4. Copy all the motor vehicle information from the Certificate of Origin or Vehicle Title. Be very careful when copying the vehicle identification
number. Provide mileage displayed on the vehicle's odometer. (This application cannot be processed without odometer information.)
5. If applicable, provide the name and address of the bank or other institution with a financial interest (lien) in the motor vehicle.
6. You must sign and date the application and it must bear the Mission seal.

OFFICE OF FOREIGN MISSIONS USE ONLY
NOTATIONS (Please include the date and your initials.)

OFM USE ONLY

Time/Date (mm-dd-yyyy) Received
PRIVACY ACT STATEMENT
AUTHORITIES: The information is sought pursuant to Vienna Convention on Diplomatic Relations of 1961; Vienna Convention on Consular Relations
of 1963; Diplomatic Relations Act (22 U.S.C. 254a-e); International Organizations Immunities Act (22 U.S.C. 288e (a)); Foreign Missions Act of 1982
(22 U.S.C. 4301-4316) as amended.
PURPOSE: The information solicited on this form will be used to adjudicate requests for diplomatic motor vehicle title(s) for foreign mission members.
ROUTINE USES: The information provided on this form may be provided to other federal agencies for law enforcement, administrative or other
statutorily authorized purposes as covered under STATE 36, Security Records. This information also may be provided to the employing foreign
government or international organization.
DISCLOSURE: Providing this information is voluntary; Failure to provide the information requested on this form may result in denial of diplomatic
motor vehicle title(s) for foreign mission members.
PAPERWORK REDUCTION ACT STATEMENT
*Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time required for searching
existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final collection.
You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments on the
accuracy of this burden estimate and/or recommendations for reducing it, please send them to: M/OFM, 3507 International Place NW, Washington,
DC 20008.
DS-102

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