BMV FORM NO. (2019-12) – REV. Jan. 21-2020
BMV FORM NO. (2019-12) – REV. Jan. 21-2020 (PRINT) FIRST NAME MIDDLE NAME LAST NAME RESIDENCE ADDRESS STREET: CITY: ZIP: MAILING ADDRESS ADDRESS: CITY: ZIP: BIRTH DATE _______ ________ ________ SOCIAL SECURITY NUMBER _________ _________ __________ EMAIL ADDR.: PHONE #: SEX BLOOD TYPE ORGAN DONOR YES NO GLASSES YES NO HEIGHT _____FT _____IN WEIGHT __________ LBS EYE COLOR: HAIR COLOR: PLACE OF BIRTH MILLITARY DRAFT REGISTRATION “BY SUBMITTING THIS APPLICATION, I AM CONSENTING TO REGISTRATION WITH THE SELECTIVE SERVICE SYSTEM, IF SO REQUIRED BY FEDERAL LAW. IF UNDER (18) YEARS OF AGE, I UNDERSTAND THAT I WILL BE REGISTERED AS REQUIRED BY FEDERAL LAW WHEN I ATTAIN EIGHTEEN (18) YEARS OF AGE. …
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BMV FORM NO. (2019-12) – REV. Jan. 21-2020 (PRINT) FIRST NAME MIDDLE NAME LAST NAME RESIDENCE ADDRESS STREET: CITY: ZIP: MAILING ADDRESS ADDRESS: CITY: ZIP: BIRTH DATE _______ ________ ________ SOCIAL SECURITY NUMBER _________ _________ __________ EMAIL ADDR.: PHONE #: SEX BLOOD TYPE ORGAN DONOR YES NO GLASSES YES NO HEIGHT _____FT _____IN WEIGHT __________ LBS EYE COLOR: HAIR COLOR: PLACE OF BIRTH MILLITARY DRAFT REGISTRATION “BY SUBMITTING THIS APPLICATION, I AM CONSENTING TO REGISTRATION WITH THE SELECTIVE SERVICE SYSTEM, IF SO REQUIRED BY FEDERAL LAW. IF UNDER (18) YEARS OF AGE, I UNDERSTAND THAT I WILL BE REGISTERED AS REQUIRED BY FEDERAL LAW WHEN I ATTAIN EIGHTEEN (18) YEARS OF AGE. “ WARNING UNDER TITLE 20, SECTION 548 VIC, IT IS IN VIOLATION “TO USE FALSE OR FICTITIOUS NAMES IN ANY APPLICATION FOR A DRIVER’S LICENSE OR IDENTIFICATION CARD, OR KNOWINGLY TO MAKE A FALSE STATEMENT, KNOWINGLY CONCEAL A MATERIAL FACT OR OTHERWISE COMMIT A FRAUD IN ANY SUCH APPLICATION.” _____________________________________________ _____________________ Signature Date No appointment will be given by phone. Cancellation must be made within 48 hours prior to the test date by phone or in person. If test is not canceled, payment will be required for a new appointment. Please bring your own vehicle (NO RENTAL) proceed to the BMV with a driver who has a valid V.I. Driver’s License. Emergency brake must be in the center of the vehicle. TO CANCEL CALL 340-713-4268 WITHIN 48 HOURS For BMV Office Use ONLY. Receipt Number Appointment Date Time Authorized Date Written Test / Road Test Written Test / Road Test Written Test / Road Test Written Test / Road Test GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES OFFICE OF THE GOVERNOR BUREAU OF MOTOR VEHICLES APPLICATION FOR FIRST TIME VI DRIVER’S LICENSE MEDICAL FORM INFORMATION ON THE BACK TO BE FILLED OUT BY A LICENSED PHYSICIAN SIGN BMV FORM NO. (2019-12) – REV. Jan. 21-2020 INFORMATION TO BE FILLED OUT AND SIGNED BY A LICENSED PHYSICIAN