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New Jersey Universal Fingerprint Form www. bioapplicant. com/nj 1 Originating Agency Number ORI 2 Category 3 Statute Number NJ920510Z REK 45 15-9 4 Reason for Fingerprinting 5 Document Type REAL ESTATE SALES/BROKERS/SALESPERSON 6 Payment Information 67. PLEASE PRINT LEGIBLY. It is required you present this completed Universal Fingerprint Form IDGNJAPP110113 at your scheduled appointment. Appointment Scheduling Scheduling is available anytime at www. bioapplicant. com/nj. Appointments may also be scheduled through our Call Center. You must have this form Blocks 1 through 26 completed prior to scheduling your fingerprint appointment via the website or call center. PLEASE PRINT LEGIBLY. It is required you present this completed Universal Fingerprint Form IDGNJAPP110113 at your scheduled appointment. 20 RB1 7 Contributor s Case Unique Identifier 8 Miscellaneous REBSL 9 First Name 10 MI 12 Daytime Phone Number 11 Last Name 13 Social Security Number Optional 14 Date of Birth 15 Height 16 Weight - 17 Maiden or Alias Last Name 18 Place of Birth US State if US Citizen Country for all others 19 Country of Citizenship 20 Home Address Address City 21 Gender Select one 22 Hair Color State 23 Eye Color Female Male Both 25 Occupation / Position with respect to Requirement Zip 24 Race Select One A Asian/ Pacific Islander includes Asian Indian B Black I American Indian / Alaska Native W White Includes Hispanic/ Spanish Origin U Unknown 26 Employer / Organization Name with respect to Requirement Employer Address Identification Requirement - Identification must be presented at the time of printing. Identification presented MUST be one 1 document that is current not expired. A combination of documents will not be accepted* The single document must include the following criteria Photo Name Address home/employer Date of Birth and is issued by a Federal State County or Municipal entity for Identification purposes. Examples of acceptable ID are 1 Valid U*S* State Photo Driver s License/ Non Driver s License 2 U*S* Passport 3 USCIS Permanent Resident ID Card issued after 5/10/2010 and 4 USCIS Employment Authorization Card issued after 10/31/2010. Please READ this form carefully and follow all of the instructions provided by your agency/employer to complete the fingerprint process. You must have this form Blocks 1 through 26 completed prior to scheduling your fingerprint appointment via the website or call center. Appointment Scheduling Scheduling is available anytime at www. bioapplicant. com/nj. Appointments may also be scheduled through our Call Center. English and Spanish speaking agents are available at 1-877-503-5981 Monday through Friday 8 00AM to 5 00PM EST and Saturday 8 00AM to 12 Noon EST. Payment When an Applicant is responsible for payment Payment Is Required at the time of scheduling. The following forms of payment are accepted Visa MasterCard or electronic debit ACH from a checking account accounts will be debited immediately. Money Order is the only form of payment accepted at the enrollment center. Cancel/ Reschedule Appointments may be canceled or rescheduled via the website or the call center before the deadline of 5PM EST the business day prior to the scheduled appointment Saturday Noon for Monday appointments.

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