Form 447-Nc - Application For A Non-Commercial Credential (Class D, E, F, G, M, Or An Id) Page 2
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1
2
3QUESTIONS 1 through 12 MUST BE ANSWERED FOR PERMITS AND LICENSES
(only questions 1 - 4 for an identification card)
1. Are you a resident of South Carolina?.........................................................................................................................................
Yes
No
2. Are you a citizen of the United States?........................................................................................................................................
Yes
No
3. Do you now have or have you ever had a South Carolina identification card, beginner’s permit, driver’s license, or moped
license? If yes, give the number and name if different from number and name given on this application ……………………….
Yes
No
__________________________________________________________________________________________________
4. Do you now have or have you ever had an identification card, beginner’s permit, driver’s license, or moped license from
another state or country?
If yes, list information from last time issued. State/Country_________________________
Yes
No
License Number ___________________and Issue Date_____________________.
Do not answer the following questions if you are only applying for an Identification Card.
5. Is your beginner’s permit, driver’s license, moped license, or privilege to drive suspended, cancelled, revoked or disqualified
in any state? If yes, where? ______________________ when last?___________________________________
Yes
No
6. Have you recently surrendered your beginner’s permit, driver’s license, or moped license in court or to a law enforcement
officer? If yes, when? __________________Reason ________________________________________________________
Yes
No
7. In the past 12 months, have you experienced a loss of consciousness, muscular control or seizure?.....................................
Yes
No
8. a) In the past six months, have you experienced a heart attack or heart surgery?.................................................................
Yes
No
b) Has your doctor recommended you not drive or placed restrictions on your driving at this time? ……………………………
Yes
No
If the answer to “b” is yes, what are the restrictions? ______________________________________________________
9. Have you had a stroke and not recovered sufficiently to safely operate a motor vehicle at this time? ……………….………….
Yes
No
10. Are you a habitual user of alcohol or any other drug to a degree which prevents you from safely operating a motor vehicle at
this time?......................................................................................................................................................................................
Yes
No
11. Do you have any mental or physical condition preventing you from safely operating a motor vehicle at this time?....................
Yes
No
If yes, please list condition(s): __________________________________________________________________________
12. Has your doctor recommended you not drive or placed restrictions on your driving at this time?...............................................
Yes
No
If yes, what are the restrictions? __________________________________________________________________
INSURANCE INFORMATION
(Check and complete the statement that applies to you.)
Under penalties of perjury, I declare that I am insured with the following insurance company and will maintain liability insurance throughout the
___________________________________________________________
issuance period. COMPANY NAME:
No motor vehicle required to be registered in South Carolina is owned by me or any relative residing in my household.
CONSENT FOR MINOR
-
Must be completed for all unemancipated applicants under the age of 18. I am a parent or guardian of the unemancipated
minor applicant. (1) If guardian, please provide documentation. (2) Responsible adult must complete Form 447-CM.
(3) Emancipated minors must submit one of the following as proof of emancipation (Only the original or certified copies will be accepted):
Court Order
Certificate of Marriage
Active Military Orders
I consent to the issuance of a beginner’s permit and/or driver’s license. I accept responsibility for the actions of the minor applicant as outlined
in Section 56-1-110 of the South Carolina Code of Laws. To be released from this responsibility before the applicant reaches age 18,
I understand that I must submit a written request for release to the Department of Motor Vehicles to have this application and the applicant’s
beginner’s permit or driver’s license cancelled.
RELATIONSHIP TO MINOR APPLICANT
PRINTED NAME
SIGNATURE
DATE
FATHER’S NAME (PRINT)
ADDRESS
ID/DL#
PHONE #
MOTHER NAME (PRINT)
ADDRESS
ID/DL#
PHONE #
I CERTIFY under penalty of perjury that all information and statements made in this application are true and correct as of the date of this
application. I also CERTIFY that I do not have a valid driver’s license other than the one(s) reported in questions #3 and #4 on page one and
that my privilege to operate a motor vehicle is not now or subject to be suspended, cancelled, revoked or disqualified at the time of this
application.
I understand that I am receiving a S.C. credential based on the information provided on this application, and that SCDMV will verify all
information. I also understand that if my privilege to drive is ever suspended, cancelled or revoked in South Carolina or any other state, my S.C.
license will be revoked until I have met all reinstatement requirements in South Carolina and any other states.
PRINTED NAME
SIGNATURE
DATE
FOR DMV OFFICE USE ONLY
Exchanging Out-of-State Permit for a SC Permit or License STATE:
OOS BP/DL NO.:
TYPE:
Duplicate
Modified
Original
Provisional
Re-exam
Reissue
Renewal
Route Restricted
Temporary Alcohol
CLASS:
D
E
F
G (Moped)
ID
M (Motorcycle)
RESTRICTIONS:
IDENTIFICATION SUBMITTED:
Birth Certificate
Passport/Visa
SSN
Proof of Residency
Knowledge Test
Hearing
Deaf
Poor
Good
Date:__________
Passed
Failed
Comments:______________________
Impaired:
Date:__________
Passed
Failed
Comments:______________________
Missing
No
Yes:________________________
Extremities:
Date:__________
Passed
Failed
Comments:______________________
Vision
Right
Left
Both
Skills Test
With corrective lens
20/
20/
20/
Date:__________
Passed
Failed
Comments:______________________
Without corrective lens
20/
20/
20/
Date:__________
Passed
Failed
Comments:______________________
Office Number: _________________
Date:__________
Passed
Failed
Comments:______________________
Employee Signature:____________________________________
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