Self-Certification Affidavit printable pdf download

Failure to return this form to the Alabama Law Enforcement Agency will result in the cancellation of

your commercial driver license.

Self-Certification Affidavit (please print)

Name of Driver:

Alabama License No.:

IMPORTANT: Recent changes in federal regulations 49 CFR 383, 384, 390 and 391 require drivers of

commercial motor vehicles to certify the type of operation they’re engaged in. Effective January 30,

2012, all Class A, B, or C drivers must submit this affidavit. *If you check the first self-certification box

below, you must also submit a copy of your current medical card/certificate and always maintain a

current medical card/ certificate on file with ALEA.*

Are you submitting a copy of your medical card/certificate? YES

(Please circle yes or no)

Please check only one of the following Self-Certification categories that apply to you.

I certify my commercial transportation is:

 Non-excepted Interstate and subject to 49 CFR part 391. *I am required to carry a DOT Medical

Card/Certificate* (medical card/certificate and this affidavit must be submitted)

 Excepted Interstate, but operating exclusively in transportation or operations excepted under

49 CFR 390.3 (f), 391.2, 391.68, or 398.3 *I am NOT required to carry a DOT Medical

Card/Certificate* (only this affidavit must be submitted) Examples of excepted categories:

Transportation performed by Federal and State Government and Churches. For a complete list

of excepted categories, please refer to the 49 CFR codes above.

 Non-excepted Intrastate and subject to Alabama driver qualification requirements. *My CDL

has a W-Restriction due to an Alabama issued Medical Waiver* (only this affidavit must be

submitted)

 Excepted Intrastate, but operating exclusively in transportation or operations excepted from all

or part of the State driver qualification requirements. (only this affidavit must be submitted)

Driver’s Signature

Date

Please mail or fax the medical card/certificate (if applicable) and this Self-Certification affidavit no later

than 10 days prior to renewing your commercial driver license. Mail or fax to

Alabama Law Enforcement Agency

For questions, please e-mail:

Driver License Division

e-mail:

cdlmedicalmerger@dps.alabama.gov

CDL Unit P.O. Box 1471

334-353-1980 – fax number

Montgomery, Al 36102-1471

Self-Certification Affidavit