Form Dl-405a - Commercial Driver'S License (Cdl) Holders Medical Certification Requirements
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1
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3South Carolina Department of Motor Vehicles
Commercial Driver’s License (CDL) Holders
DL-405A
Medical Certification Requirements
(Rev. 3/12)
THIS ENTIRE FORM MUST BE COMPLETED BY THE APPLICANT
and must be completed in black or blue ink.
CURRENT LEGAL NAME (FIRST, MIDDLE, LAST, SUFFIX)
DATE OF BIRTH
SOCIAL SECURITY NUMBER
DRIVERS LICENSE NUMBER
/
/
-
-
CHECK THE APPROPRIATE BOX FOR THE TYPE OF OPERATION THAT APPLIES TO YOU
See Frequently Asked Questions (FAQ) for explanations
NON-EXCEPTED INTERSTATE
(NI)
Operates in interstate commerce and meets the qualification
(Required to have a DOT medical
requirements under 49 CFR part 391
card/certificate)
EXCEPTED INTERSTATE
(EI)
Operates in interstate commerce, but engages exclusively in
(See FAQ Sheet for list)
transportation or operations excepted under 49 CFR 390.3(f),
391.2, 391.68 or 398.3
NON-EXCEPTED INTRASTATE
(NA)
Operates only in intrastate commerce and is subject to and meets
(18-20 years of age and/or
State driver qualification requirements.
license with an “I” restriction)
EXCEPTED INTRASTATE
(EA)
Operates only in intrastate commerce, but engages exclusively in
(Not applicable in South Carolina)
transportation or operations excepted from State driver
qualification requirements.
I certify under penalty of perjury that all statements above are true and correct.
SIGNATURE OF APPLICANT
DATE
If your CDL is current, you may submit this form along with any other documents that apply to you
(Medical Examiner’s Certificate, Federal Waiver, Skills Performance Evaluation) using one of the
following options:
1) Mail this form and copies of medical documents to:
SCDMV - CDL Help Desk
PO Box 1498
Blythewood, SC 29016-0028
2) Scan the documents and then email them to: CDLHelpDesk@scdmv.net
3) Fax this form and medical documents to the CDL Help Desk. Fax number is (803) 896-2676
4) Deliver this form and medical documents to your local SCDMV office. A list of office locations and
hours can be found on our website
Please contact the CDL Help Desk at (803) 896-2673 if you have any questions regarding this form.
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