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CDL Medical Self-Certification Form

State of Maine Secretary of State Bureau of Motor Vehicles CDL Compliance Unit MVE 64C Revised 7/15 CDL Medical Self-Certification Form Name of Driver: ME Lic #: (Please print) I certify that I meet the following Medical requirements contained in Section 391 of the Federal Motor Carrier Safety Regulations (FMCSR). Please check only one of the following Self-Certification driving types that apply to you. Non-excepted Interstate: I operate or expect to operate in interstate commerce.

Has a gross vehicle weight rating or gross combination weight rating, or gross vehicle weight or gross combination weight, of 4,536 kg (10,001 pounds) or more, whichever is greater; or Is designed or used to transport more than 8 passengers (including the driver) for compensation; or

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