13 TRANSFER CERTIFICATE
Address: City: State:
Zip: Phone: Date of Transfer: Odometer at Transfer:
Transferred to: Address:
City: State: Zip:
I have read and understand all the terms and conditions listed above:
Signature of Former Owner: Date:
S
ignature of New Owner: Date:
Y
our transfer request must include the following:
• Current and new VSC holder signatures
• Transfer date and mileage
• Current VSC holder's signature on the transfer request form OR copy of Power of Attorney and signature of that person who
i
s authorized to sign for the current VSC holder
• Change of Ownership documents (at least one of the following: copy of title, registration application, Bill of Sale, and odometer
reading on that date)
• Copies of complete maintenance records indicating the vehicle has been maintained in accordance with the manufacturer's
recommendations OR inspection of the vehicle by a Nissan dealer and completion of a Vehicle Inspection Report (inspection
at owner's expense)
• Transfer fee, by personal check or money order, payable to ‘Nissan Extended Services North America’ or ‘NESNA’. Refer to
Section 12 (How Do I Transfer My VSC?) for transfer fee information.
Mail the items listed above, a copy of this Transfer Certificate and your transfer fee payment to:
NISSAN EXTENDED SERVICES NORTH AMERICA
VEHICLE SERVICE CONTRACTS
P.O. BOX 685004 (A-4-F)
FRANKLIN, TN 37068-5004
If you have any questions, please contact Nissan Consumer Affairs at 800-647-7261.
VEHICLE/AGREEMENT INFORMATION
Purchaser:
Purchase Price:
Agreement:
Deductible:
VIN:
Year:
Make:
Model:
Original Manufacturer’s New Vehicle Warranty (In-service)
Date: Odometer Reading:
Agreement Effective
Date: Odometer Reading:
Agreement Expiration (whichever occurs first)
Date: Odometer Reading:
Lienholder:
Dealer:
Issuer: NISSAN EXTENDED SERVICES NORTH AMERICA, GP
VEHICLE SERVICE CONTRACTS
P.O. BOX 685004 (A-4-F)
FRANKLIN, TN 37068-5004
7
RC0412-061212 — Revision date: 06/12/12
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