PennDOT - Commercial Learner's Permit

INITIAL/EXTEND/UPGRADE OF LEANER'S PERMITALL NEW APPLICANTS MUST SUBMIT A SELF CERTIFICATION FORM (DL-11CD)ADRIVER'S LICENSE NUMBER LAST name JR/ETC DATE OF BIRTH SOCIAL SECURITY NUMBER TELEPHONE NUMBER (8:00 :30 ) E-MAIL ADDRESSM onth Day YearFIRST name MIDDLE NAMER estriction Removal(Check all that apply) photo FEE - Required (Except as noted on back of form) $ FEE (see back*)$ 7-12 Months ..$ Months ..$ Months ..$ Months ..$ FEE - Complete if you are upgrading from a non- Commercial license to a CDL.

DRIVER'S LICENSE NUMBER LAST NAME JR/ETC. DATE OF BIRTH SOCIAL SECURITY NUMBER TELEPHONE NUMBER (8:00 A.M.-4:30 P.M.) E-MAIL ADDRESS. Month Day Year. FIRST NAME MIDDLE NAME. Restriction Removal (Check all that apply) PHOTO FEE - Required (Except as noted on back of form) NOTE: Duplicate license issued at completion of …

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