Cdl Self-Certification
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CDL Self-Certification
Classification and
Medical Documentation
P.O. Box 201430 Helena, MT 59620-1430
Phone (406) 444-3244
Fax (406) 444-1987
doj.mt.gov/driving/
IF YOU DO NOT RETURN THIS COMPLETED FORM WITHIN 90 DAYS OF RECEIVING IT,
YOUR CDL WILL BE DOWNGRADED TO A CLASS D DRIVER LICENSE.
THIS FORM SERVES TWO PURPOSES: allows commercial drivers to (1) self-certify, and (2) submit a
Medical Examiner's Certificate (MEC), if required for their type of operation.
st
nd
rd
Legal Last Name
Legal First Name
Legal Middle Name
Suffix (Jr., Sr., 1
, 2
, 3
)
Date of Birth (mm/dd/yyyy)
Driver License Number
Daytime Phone Number
(
)
Address on Driver License
City
State
Zip Code
All commercial driver license (CDL) holders must determine the type of business they operate in and certify to
that type of commercial operation in order to maintain their CDL.
Based on the type of commercial operation selected, you may be required to submit a copy of your MEC to the
Montana Motor Vehicle Division (MVD).
I certify my commercial driving is (check only one of the following three options):
Interstate Non-Excepted: Operates in interstate commerce and meets the qualification requirements
under 49 CFR part 391*.
You must submit a valid Medical Examiner’s Certificate (MEC). In addition, prior to the expiration of
your current MEC, you must renew your MEC and submit a copy to the MVD.
Montana-Only (Intrastate) Non-Excepted: Operates in only Intrastate commerce and meets either the
qualification requirements under 49 CFR part 391* or state qualification requirements.
You must submit a valid Medical Examiner’s Certificate (MEC) or Montana Medical Certificate. In
addition, prior to the expiration of your current MEC, you must renew your MEC and submit a copy to
the MVD.
You must check at least one box on page 2 to claim the following exception:
Interstate Excepted: Operates in interstate commerce but engages exclusively in transportation or
operation excepted under 49 CFR 390.3(f), 391.2, 391.68, or 398.3*.
Submission of Medical Examiner’s Certificate (MEC) is not required
IMPORTANT: If you checked the box for Interstate Non-Excepted or Montana-Only Non-Excepted, you
must submit copy of your Medical Examiner’s Certificate (MEC) and any accompanying waivers or
variances along with this self-certification. If you are a non-excepted driver, it is illegal to drive a
commercial motor vehicle in Montana without a valid MEC, and failure to keep your medical certification status
information current with the state may result in the downgrade of your interstate CDL to a base, Class D
license.
Signature of Applicant:
Date:
Mail or fax this completed and signed form, with applicable documentation,
to the address or fax number above.
*To reference the Code of Federal Regulations (CFR), visit
21-1201 (7/12)
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