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BMV FORM NO. (2019-12) – REV. Feb 05, 2025 APPLICANT INFORMATION FIRST NAME MIDDLE NAME LAST NAME DATE OF BIRTH (MM/DD/YYYY) SSN PHONE NO. EMAIL ADDRESS GENDER _____ MALE _____ FEMALE _____ X HEIGHT ___ FT____IN WEIGHT ______LBS EYE COLOR HAIR COLOR BLOOD TYPE ORGAN DONOR __YES __NO GLASSES __YES __NO RESIDENTIAL - STREET ADDRESS CITY STATE ZIP CODE MAILING ADDRESS CITY STATE ZIP CODE VEHICLE TYPE _____ PRIVATE LICENSE _____ PUBLIC LICENSE _____ COMMERCIAL LICENSE DISCLAIMERS WARNING UNDER TITLE 20, SECTION 548 VIC, IT IS IN VIOLATION “TO USE FALSE OR FICTITIOUS NAMES ON ANY APPLICATION FOR A DRIVER’S LICENSE OR IDENTIFICATION CARD, OR KNOWINGLY TO MAKE FALSE STATEMENT, KNOWNINGLY TO CONCEAL A MATERIAL FACT OR OTHERWISE COMMIT A FRAUD IN ANY SUCH APPLICATION.” MILITARY 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.” SIGNATURE OF APPLICANT DATE THIS SECTION MUST BE COMPLETED ONLY BY A LICENSED EYE CARE PROFESSIONAL **DO NOT RETURN THIS FORM TO AN INDIVIDUAL REQUIRING CORRECTIVE LENSES UNTIL NEW LENSES HAVE BEEN FITTED** VISUAL EXAMINATION DISTANT VISION ONLY RIGHT EYE LEFT EYE BOTH EYES WITHOUT CORRECTIVE LENS/ES 20 / ____ 20 / ____ 20 / ____ WITH CORRECTIVE LENS/ES 20 / ____ 20 / ____ 20 / ____ NEW PRESCRIPTION 20 / ____ 20 / ____ 20 / ____ VISUAL FIELD IN HORIZONTAL MERIDIAN 20 / ____ 20 / ____ 20 / ____ Comments: CONCLUSION/APPROVAL I, ___________________________________________________, have reviewed the applicant's vision examination results and confirm they meet the requirements for a driver’s license, thereby approving its issuance. Signature of Professional: ______________________________ Date: _______________ License Number: _____________________________________ Contact Information: _____________________________ 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 BMV FORM NO. (2019-12) – REV. Feb 05, 2025 Notes for First Time VI Driver’s License Medical Form: • Visual Standards for Public Transportation and/or Operators: o A correctable visual acuity of 20/30 Snellen in each eye. If corrective glasses are required to achieve 20/30 visual acuity, unbreakable glasses or an additional pair of glasses should be mandatory. o A minimum field of vision of 70 degrees in the horizontal meridian for each eye and 140 degrees for both eyes combined. • Visual Requirements for Private Car Operators: o A correctable visual acuity of 20/40 Snellen in the better eye. o A minimum field of vision of 70 degrees in the horizontal meridian for each eye and 140 degrees for both eyes combined. o Eye re-examinations should be conducted every three years. Important Notes & Process for Obtaining a Driver’s License 1. Obtain an Application/Medical Form • Get an Application/Medical Form for a Driver’s License (valid for 1 year) from the Bureau of Motor Vehicles (BMV). • The application must be completed by you or a locally certified physician. • If you are under 18 (but at least 16 years old), obtain the Parent or Guardian Financial Consent Form (BMV FORM NO. 2019-012). This form needs to be signed, notarized, and returned to the BMV. • All minors must present a Certificate of Completion from a certified driving education program. 2. Fill Out the Correct License Form • IMPORTANT: You must fill out either a Real ID Driver’s License form or a Limited Purpose Driver's License form, depending on your situation. These forms will include the specific documentation and requirements you need to submit. 3. Purchase the Driver’s Manual ($20.00). Purchase the driver’s manual to help you prepare for the Knowledge Skills Exam. 4. Schedule and Take the Knowledge Skills Exam ($20.00). Purchase and schedule the Knowledge Skills Exam. A passing grade of 75% or higher is required to proceed. 5. Purchase the Learner’s Permit ($20.00). After passing the Knowledge Skills Exam, purchase your Learner’s Permit, which will be valid for six (6) months. 6. Schedule and Take the Road Skills Exam ($20.00). Once you’ve completed all the above, schedule and take the Road Skills Exam. 7. Obtain Your 5-Year Driver’s License ($55.00). After successfully passing the Road Skills Exam, you will be issued a 5-year driver’s license for a fee of $55.00. Online Appointments. You can now schedule your appointments online or by phone. To cancel an appointment, you must do so at least 48 hours in advance. Cancellations can be made by calling or visiting your nearest BMV office. For more information, please contact: BMV STX: (340)713-4268 | BMV STT: (340)774-4268 | BMV STJ: (340)776-6262 | or visit bmv.vi.gov