Brotherhood Mutual Insurance Company Ministry Driver Screening Form (A99) Completed Form Examples and Samples
View filled-out examples and samples of the Brotherhood Mutual Insurance Company Ministry Driver Screening Form (A99). Learn how to correctly complete the form for your church or ministry's volunteer and staff drivers, ensuring compliance and proper screening.
Brotherhood Mutual Ministry Driver Screening Form (A99) Example
How this form was filled:
This example shows how to fill out the Ministry Driver Screening Form (A99) for a prospective volunteer church van driver. It includes the applicant's personal information, driver's license details, a clear driving history, and the necessary signed authorization for the ministry to obtain a Motor Vehicle Report (MVR).
Information used to fill out the document:
- Ministry/Organization Name: Grace Community Church
- Applicant's Full Name: Sarah Marie Johnson
- Date of Birth: 06/15/1986
- Full Address: 456 Oak Avenue, Anytown, IL 54321
- Phone Number: 555-123-4567
- Driver's License Number: J525-1986-0615
- State of Issue: IL
- License Expiration Date: 06/15/2028
- Years of Driving Experience: 24
- Accidents in last 3 years?: No
- Moving Violations in last 3 years?: No
- License ever suspended or revoked?: No
- Applicant Signature: Sarah M. Johnson
- Date of Application: 04/22/2026
What this filled form sample shows:
- Clearly filled out ministry and applicant information sections.
- Accurate and up-to-date driver's license details, including state and expiration date.
- Honest disclosure of driving history within the past three years, a critical section for insurance screening.
- Properly completed signature and date fields, authorizing the ministry to perform necessary checks.
Form specifications and details:
| Form Name: | Ministry Driver Screening Form (A99) |
| Issuing Company: | Brotherhood Mutual Insurance Company |
| Use Case: | Volunteer driver screening for a church ministry. |
| Purpose: | To gather information and obtain consent to check the driving record of a potential ministry driver. |
Created: February 10, 2026 11:44 PM
