Fillable Printable CDL Self Certification Affidavit - Alabama
Fillable Printable CDL Self Certification Affidavit - Alabama
CDL Self Certification Affidavit - Alabama
Failure toreturn this form to the Alabama Department of Public Safety will result in the
cancellation of your commercial driver license.
Self-Certification Affidavit (please print)
Name of Driver: AlabamaLicense 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, allClassA, B, or C drivers must submit this affidavit. *If you check the first self-certification box
below, you must alsosubmit a copy of your current medical card/certificate and always maintain a
current medical card/ certificate on file with the Alabama Department of Public Safety.*
Are you submitting acopy of your medical card/certificate? YES NO (Please circle yes or no)
Please check only oneof the followingSelf-Certification categories that apply to you.
I certify my commercial transportation is:
Non-exceptedInterstate and subject to 49 CFR part 391.*I am required to carry a DOT Medical
Card/Certificate* (medical card/certificateand this affidavit must be submitted)
ExceptedInterstate,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 byFederal and State Government and Churches. For a complete list of
excepted categories, please refer to the 49 CFR codes above.
Non-exceptedIntrastate and subject to Alabamadriver qualificationrequirements. *My CDL has
a W-Restriction due to an Alabama issued Medical Waiver*(only this affidavit must be submitted)
ExceptedIntrastate, 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 themedical 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
AlabamaDepartmentof PublicSafety For questions, please e-mail:
Driver License Division e-mail: cdlmedic[email protected]
CDL Unit
P.O. Box 1471 334-353-1980 – fax number
Montgomery, Al 36102-1471
