CTION UNIT 60 STATE STREET, WETHERSFIELD, CT 06161-5056 On the Web at: ct.gov/dmv Telephone: (860)263-5148 Fax: (860)263-5591 INSTRUCTIONS: 1. 2. 3. PART A must be completed by applicant. PART B must be completed by a licensed physician. The applicant must return this form by mail to the address above. This form must be submitted with the Request for a Connecticut Driver's License/Identification Card by Mail (B-350). Physicians (IMPORTANT): If the applicant s medical condition is a chronic h.
Open form follow the instructions
Easily sign the form with your finger
Send filled & signed form or save
How to fill out the CI-1 Rev. 9-14.ofm - CT.gov - Ct online
This guide provides a clear and supportive approach to filling out the CI-1 Rev. 9-14.ofm form for renewing or obtaining a duplicate driver's license or identification card by mail due to medical conditions. Whether you are the applicant or the licensed physician, this step-by-step guide will help you navigate the process effectively.
Follow the steps to complete the CI-1 Rev. 9-14.ofm form.
- Click the 'Get Form' button to obtain the CI-1 Rev. 9-14.ofm form and open it in the designated editor.
- Fill out Part A of the form as the applicant. Enter your date of birth, name, daytime telephone number, driver's license or identification card number (if known), and your current address. Provide your email address and indicate whether we may contact you via email regarding your request.
- Affirm your inability to appear in person by signing and dating the statement provided in Part A. Make sure you understand the legal implications of false statements.
- Once Part A is completed, you will need to provide this form to an authorized physician for Part B to be completed. The physician must sign and date Part B certifying your medical condition.
- The physician must also provide their name, medical license number, licensing state, office address, office telephone number, and email address. They need to confirm whether they can be contacted via email to verify their signature.
- Ensure that Part B indicates whether your condition is temporary and, if so, provide an estimated date of recovery. The physician must sign and date this section.
- After both parts are filled out, mail the completed form to the address specified at the top of the document. Ensure all information is accurate to prevent delays.
- Lastly, upon submission, remember to save any changes you have made, and if necessary, download, print, or share the filled-out form as per your needs.
Complete your documents online effortlessly, ensuring you follow each step for a smooth submission process.
Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Related content
by F Data — 1. Meeting the Growth Management Challenge in Growing Communities,...
by F Data — 1. Meeting the Growth Management Challenge in Growing Communities,...
CONNE C TOR WH E N SASE I S USE D O N LBAC 2S O. B. KEYBOARD. CONNECTOR r -- i. S E E N...
Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
If you believe that this page should be taken down, please follow our DMCA take down process here.