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  • Massdot Form T21893 2014

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Its them to a one year medical certificate. If condition #6 is selected on your medical certificate and you do not fall under the grandfather clause, condition #6 was most likely chosen by the medical examiner in error. You should return to the medical examiner to request a revised medical card. Telephone #: Issue Date: Medical Examiner’s Name: Specialty Code: (MD, DO, PA, CH, AN, or Other) License No: Issuing State: Suffix: Medical Examiner’s National Registry No: Medical Certificatio.

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How to fill out the massDOT Form T21893 online

Completing the massDOT Form T21893 is essential for all commercial driver’s license holders to ensure compliance with federal regulations. This guide will help you navigate the form and provide clear, step-by-step instructions tailored for your needs.

Follow the steps to successfully fill out the form.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin by entering your driver information. Fill in your last name, first name, and middle name as applicable. Include your street address, city, state, and zip code.
  3. Select your self-certification category from the given options. Make sure to review the definitions on page two of the form to choose the category that accurately reflects the type of commerce you engage in.
  4. If you are part of the Non-Excepted Interstate (NI) or Non-Excepted Intrastate (NA) categories, you must complete the medical certificate portion on page two and attach a copy of your medical certificate.
  5. Sign the form to certify that the information provided is true and complete. Include the date of signing.

Complete your massDOT Form T21893 online today to ensure your compliance and maintain your commercial driving privileges.

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massDOT Form T21893
This form is available in several versions.
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2015 Massachusetts Form T21893
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  • 2015 Massachusetts Form T21893
  • 2014 massDOT Form T21893
  • 2012 massDOT Form T21893
  • Cdl Self Certification Form
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