Please be advised that when requesting records from Puerto Rico for insurance and
employment purposes, the end-user is required to have a release form signed by the
prospective applicant/employee. This release form must be faxed to Softech at 1-305-6476504.
PUERTO RICO SPECIFIC INFORMATION:
1. Client Information
Softech Account Number
2. Application/Subject Information
Last Name, First Name, MI (If driver has more than one last name please list all.)
Driver’s License Number
Date of Birth
Social Security Number
3. Driver Authorization
Driver’s Signature and Date (Please have applicant/employee sign and date.)
IMPORTANT:
The Puerto Rico Release form:
1. Must be completed and faxed to Softech at 1-305-647-6504 in order for the request to be filled.
2. DO NOT SEND A FAX COVER SHEET
3. Must be completed as directed and the original kept on file by the end-user/employer.
Created 1/09
PR Release Instructions
Rev. 8/15
Softech Account# _______________
Puerto Rico Authorization for
Release of Driving Record (Legitimate Business Purpose)
I, ______________________________________ do hereby authorize and allow Success In Action, Inc., as
agent for Softech International Inc to obtain a copy of my driver’s license abstract information which will
be used for verification of information for a legitimate business purposes.
La Autorización de Puerto Rico para la Liberación del Registro Impulsor
(Proposito Legitimo de Negocio)
Yo, _____________________________________ por la presente autorizo y doy permiso a Success In
Action, Inc., como agente de Softech International Inc a obtener una copia de la información abstracta
de mi licencia de conducir, la cual será utilizada para comprobar que la información obtenida es por un
propósito legítimo de la Compañía.
_____________________________________________________________________________________
Full Name (please print)/Nombre Completo (letra de molde)
_____________________________________________________________________________________
License Number/Numero de Licencia de Conducir
Date of Birth/Fecha de Nacimiento: ___________________
Social Security Number/Numero de Seguro Social: ____________________________________________
Reference: ____________________________________________________________________________
_____________________________________________________________________________________
Signature/Firma
Date/Fecha
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