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Get MD Certification of Insurance & Authorization to Operate Vehicle 2011-2024

Certification of Insurance Authorization To Operate Vehicle Applicant s Driver License I certify under penalty of perjury that insert vehicle license plate State is properly insured and registered. I understand that this vehicle will be used for the on-road driving test. In the event that the test would need to be stopped I understand that the examiner may be returning the vehicle back to the MVA and that the MVA will not be liable for any damage that may occur during this test. Insurance Company Policy Number Print Applicant s Name Applicant s Signature Date Print Name of Responsible Adult Responsible Adult s Signature Revision July 5 2011. In the event that the test would need to be stopped I understand that the examiner may be returning the vehicle back to the MVA and that the MVA will not be liable for any damage that may occur during this test. Insurance Company Policy Number Print Applicant s Name Applicant s Signature Date Print Name of Responsible Adult Responsible Adult s Signature Revision July 5 2011. .

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