Imm 46 2026

1. Click ‘Get Form’ to open the imm 46 in the editor.
2. Begin by filling in the 'Name of Registrant' as it appears in the NJIIS, followed by their 'Date of Birth' and 'Street Address'.
3. If known, enter the 'NJIIS Registry ID Number', then provide the 'City', 'State', and 'Zip Code'. Include a valid 'Daytime Telephone Number' for contact purposes.
4. Next, fill in the details of the 'Name of Parent/Guardian' and their relationship to the registrant. Also, include the name and telephone number of the current primary health care provider.
5. In the section for the individual or entity receiving the copy, print their name, street address, city, state, and zip code.
6. Complete the authorization section by printing your name as the requestor, along with your telephone number, street address, relationship to the registrant, and signature. Don't forget to date your request.
7. Finally, review all entries for accuracy before mailing your completed form along with any required identification documents to the specified address.

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