Application For Motor Carrier Certificate Before The Alabama Public Service Commission Page 2
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7SECTION II Continued
Out of State Corporations, Limited Liability Companies (LLC), Limited Partnerships (LP), Limited Liability Partnerships
(LLP) must register with the Alabama Secretary of State.
Alabama corporation, LLC, LP, or LLP,
OR
Out of State Corporation, LLC, LP, or LLP
State of Organization:
Attach Certificate of Registration from the
Alabama Secretary of State
Copy of Articles of Incorporation or Articles of Organization is attached as Appendix “A” or is already on file with the
Alabama Public Service Commission.
If you have been issued a U.S.D.O.T. number, MC number, or Alabama Public Service Commission Permit or Certificate
number, provide it here:
USDOT#
MC#
APSC#
Applicant proposes to use approximately (number of)
motor vehicles of the kind and type described in
Appendix "B" hereto attached. (Give detailed description showing type, make, model, and rated capacity).
SECTION III
Applicant has the required insurance and Forms E and H proof of coverage properly filed with the Commission.
(Form E and Form H are provided by the Insurance Company)
$100.00 filing fee paid (cashier's check or money order only)
A financial statement (balance sheet and income/expense statement) for the most recent tax year is attached
hereto as Appendix "C."
Applicant has attached hereto a Unified Carrier Registration (UCR) receipt for current year or Form B-2,
application for registration number with the statutory fee of $6.00 per vehicle.
SECTION IV
Applicant has a safety fitness rating from the United States Department of Transportation of satisfactory as
shown by Attachment "D."
OR
Applicant has attached as Appendix "D" a description of its safety program that shows compliance with
requirements of the Commission's rules and/or the rules of the United States Department of Transportation.
SECTION V
Applicant has attached its tariff showing the rates, charges, rules and practices for its household goods moving
service and the services provided in connection with the moving services, or a power of attorney issued to a
tariff publishing association.
SECTION VI
Applicant understands that the filing of this Application does not, in itself, constitute authority to operate; will
submit such additional information in connection with this Application as the Commission may require; and will comply with
requirements of the laws of the State of Alabama, and the rules and regulations of the Commission made thereunder, as are
applicable to intrastate transportation of property.
Revised 2012
APSC Form No. 14H
-2-
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