EXEC 201X Form: Information Security Disclosure Firm PDF

EXEC 201X Form – The EXEC 201X form, officially titled the Information Security and Disclosure Statement – Firm, is a mandatory California DMV document for businesses that access confidential or restricted motor vehicle records. This guide covers everything you need to know about the EXEC 201X form, including its purpose, who must complete it, how to download the latest PDF, step-by-step completion instructions, and compliance requirements. Updated for 2026, this article draws directly from the official DMV PDF and program guidelines.

What Is the EXEC 201X Form?

The EXEC 201X form is the Information Security and Disclosure Statement Firm (revision 3/2003, still current as hosted by DMV in 2025). It requires authorized firm representatives to certify that their company and employees will protect California DMV confidential and personal information.

Firms sign this statement before gaining authorization as a CADMV information user. It applies to any business handling DMV data under programs such as the Business Partner Automation (BPA) Program, Electronic Lien and Title (ELT) Program, Interstate Carrier Program, or Traffic Violator School (TVS) systems.

Purpose of the EXEC 201X Information Security Disclosure Statement

The form ensures firms follow strict data protection rules under California Vehicle Code § 1808.47, the Information Practices Act, the Public Records Act, the State Administrative Manual, and the federal Driver’s Privacy Protection Act (18 U.S.C. §§ 2721–2725).

CADMV collects sensitive personal information (including residence addresses) to administer vehicle registration, titling, licensing, and other programs. The EXEC 201X requires firms to warrant that they will:

  • Use data only for the specific purpose in their attached agreement
  • Never disclose, sell, alter, or misuse it
  • Destroy or securely erase data after use
  • Maintain secure storage, passwords, and physical security

This protects public privacy and prevents unauthorized access or identity theft.

Who Must Complete the EXEC 201X Form?

Any firm (authorized representative or corporate officer) that will receive or access CADMV confidential information must complete and sign the EXEC 201X. This includes:

  • First-line business partners and service providers in the BPA Program
  • ELT participants and service providers
  • Interstate carriers
  • Traffic violator schools and court administrators
  • Registration services, dismantlers, and other authorized partners

Each firm must also require every employee with data access to sign the related EXEC 200X (Employee version) immediately and annually. The firm keeps the original EXEC 201X and provides copies as needed.

Key Sections of the EXEC 201X Form (Full Breakdown)

The one-page PDF form contains these structured sections:

Firm Information

  • Firm Name
  • Firm Address
  • Telephone Number

Statement of Purpose – Explains CADMV’s commitment to protecting confidential data under state and federal law.

Policies Pertaining to DMV Information – References Vehicle Code § 1808.47 and requires firms to establish confidentiality procedures.

Responsibilities (11 detailed warranties, listed verbatim in the form):

  1. Protect residence address information.
  2. Limit access to authorized employees only and require annual EXEC 200X signatures.
  3. Use data solely for the agreed purpose (no personal use).
  4. Never distribute, sell, or alter data.
  5. Avoid unauthorized additions, deletions, or false entries.
  6. Destroy or erase media after use.
  7. Provide secure storage and accountability.
  8. Create and protect secure passwords (never share or write them down).
  9. Secure terminals, equipment, and documents (e.g., never leave systems logged on unattended).
  10. Acknowledge that misuse is a public offense punishable by fine and imprisonment.
  11. Understand federal civil liability under the Driver’s Privacy Protection Act (minimum $2,500 damages plus punitive damages, attorney fees, etc.).

Certification and Signature

  • Certification under penalty of perjury (federal and California law)
  • Executed at (City, County, State)
  • Signature of Authorized Firm Representative
  • Date
  • Printed Name and Title
  • Printed Name of Firm

How to Download the Official EXEC 201X PDF?

Download the current official version directly from the California DMV:
https://www.dmv.ca.gov/portal/uploads/2025/05/EXEC-201-X-R3-2003-ASB-WWW.pdf

This is the exact file referenced in all current DMV business partner and program applications. Always use the DMV-hosted link to ensure you have the latest authorized copy.

Step-by-Step Instructions for Filling Out the EXEC 201X Form

  1. Download and print the PDF (or complete digitally if your system allows).
  2. Fill in Firm Information – Enter legal firm name, complete address, and telephone number.
  3. Review all 11 responsibilities – Read and understand every warranty.
  4. Complete the certification block – Provide city, county, and state where signed.
  5. Sign and date – Authorized representative must sign and print name/title.
  6. Retain copies – Original stays with firm management; provide copies to DMV or auditors upon request.
  7. Pair with employee forms – Immediately distribute EXEC 200X to all relevant employees and collect signed copies annually.

Submit the completed EXEC 201X as part of your program application (BPA, ELT, etc.) or renewal. Some programs require it annually.

Misuse of DMV data is a public offense under California law and can result in civil or criminal prosecution, fines, and imprisonment. Federal law allows individuals to sue for damages of at least $2,500 per violation plus punitive damages and attorney fees. DMV can revoke program authorization, disable accounts, or conduct audits at any time. Firms must retain records for the program term plus additional years as specified.

  • EXEC 200X – Information Security and Disclosure Statement (Employee version) – Required annually for every employee with access.
  • Program-specific applications (e.g., REG 4026 for BPA modifications) often require both EXEC 201X and EXEC 200X.

Why Information Security Compliance Matters for DMV Partners?

Strict adherence to the EXEC 201X protects your business from liability, maintains your DMV authorization, and upholds public trust. With increasing scrutiny on data privacy, completing this form correctly is a critical step for any California business partner, dealer, service provider, or carrier.

Direct Download Link (Official DMV):
https://www.dmv.ca.gov/portal/uploads/2025/05/EXEC-201-X-R3-2003-ASB-WWW.pdf

For the most current program requirements, always check the specific DMV portal page for your business type (Business Partner Automation, ELT, Interstate Carrier, etc.). If you need assistance with related forms or audits, contact the appropriate DMV program administrator listed on dmv.ca.gov.

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