BMV FORM NO. (2019-12) – REV. Feb 05, 2025 
 
 
 
 
APPLICANT INFORMATION 
FIRST NAME 
MIDDLE NAME 
LAST NAME 
DATE OF BIRTH (MM/DD/YYYY) 
SSN 
PHONE NO. 
EMAIL ADDRESS 
GENDER 
 
_____ MALE 
 
_____ FEMALE 
 
_____ X 
HEIGHT 
 
___ FT____IN 
WEIGHT 
 
    ______LBS 
EYE COLOR 
HAIR COLOR 
BLOOD TYPE 
ORGAN DONOR 
 
__YES __NO 
GLASSES 
 
__YES __NO 
RESIDENTIAL - STREET ADDRESS 
CITY 
STATE 
ZIP CODE 
MAILING ADDRESS 
CITY 
STATE 
ZIP CODE 
VEHICLE TYPE 
 
_____ PRIVATE LICENSE _____ PUBLIC LICENSE _____ COMMERCIAL LICENSE  
DISCLAIMERS 
WARNING 
 
UNDER TITLE 20, SECTION 548 VIC, IT IS IN VIOLATION  
“TO USE FALSE OR FICTITIOUS NAMES ON ANY APPLICATION FOR A DRIVER’S LICENSE OR IDENTIFICATION CARD, OR 
KNOWINGLY TO MAKE FALSE STATEMENT, KNOWNINGLY TO CONCEAL A MATERIAL FACT OR OTHERWISE COMMIT A FRAUD 
IN ANY SUCH APPLICATION.” 
MILITARY DRAFT REGISTRATION 
 
“BY SUBMITTING THIS APPLICATION, I AM CONSENTING TO REGISTRATION WITH THE SELECTIVE SERVICE SYSTEM, IF SO 
REQUIRED BY FEDERAL LAW. IF UNDER (18) YEARS OF AGE, I UNDERSTAND THAT I WILL BE REGISTERED AS REQUIRED BY 
FEDERAL LAW WHEN I ATTAIN EIGHTEEN (18) YEARS OF AGE.” 
 
SIGNATURE OF APPLICANT 
DATE 
 
THIS SECTION MUST BE COMPLETED ONLY BY A LICENSED EYE CARE PROFESSIONAL 
**DO NOT RETURN THIS FORM TO AN INDIVIDUAL REQUIRING CORRECTIVE LENSES UNTIL NEW LENSES HAVE BEEN FITTED** 
VISUAL EXAMINATION 
DISTANT VISION ONLY 
RIGHT EYE 
LEFT EYE 
BOTH EYES 
WITHOUT CORRECTIVE LENS/ES 
20 / ____ 
20 / ____ 
20 / ____ 
WITH CORRECTIVE LENS/ES 
20 / ____ 
20 / ____ 
20 / ____ 
NEW PRESCRIPTION 
20 / ____ 
20 / ____ 
20 / ____ 
VISUAL FIELD IN HORIZONTAL MERIDIAN 
20 / ____ 
20 / ____ 
20 / ____ 
Comments: 
CONCLUSION/APPROVAL 
 
I, ___________________________________________________, have reviewed the applicant's vision examination results 
and confirm they meet the requirements for a driver’s license, thereby approving its issuance. 
 
 
Signature of Professional: ______________________________ Date: _______________ 
 
License Number: _____________________________________ Contact Information: _____________________________ 
GOVERNMENT OF THE VIRGIN ISLANDS  
OF THE UNITED STATES OFFICE OF THE GOVERNOR  
BUREAU OF MOTOR VEHICLES  
 
APPLICATION FOR FIRST TIME VI DRIVER’S LICENSE MEDICAL FORM 
BMV FORM NO. (2019-12) – REV. Feb 05, 2025 
Notes for First Time VI Driver’s License Medical Form: 
•
Visual Standards for Public Transportation and/or Operators:
o
A correctable visual acuity of 20/30 Snellen in each eye. If corrective glasses are required to
achieve 20/30 visual acuity, unbreakable glasses or an additional pair of glasses should be
mandatory.
o
A minimum field of vision of 70 degrees in the horizontal meridian for each eye and 140 degrees
for both eyes combined.
•
Visual Requirements for Private Car Operators:
o
A correctable visual acuity of 20/40 Snellen in the better eye.
o
A minimum field of vision of 70 degrees in the horizontal meridian for each eye and 140 degrees
for both eyes combined.
o
Eye re-examinations should be conducted every three years.
Important Notes & Process for Obtaining a Driver’s License 
1. Obtain an Application/Medical Form
•
Get an Application/Medical Form for a Driver’s License (valid for 1 year) from the
Bureau of Motor Vehicles (BMV).
•
The application must be completed by you or a locally certified physician.
•
If you are under 18 (but at least 16 years old), obtain the Parent or Guardian Financial
Consent Form (BMV FORM NO. 2019-012). This form needs to be signed, notarized,
and returned to the BMV.
•
All minors must present a Certificate of Completion from a certified driving education
program.
2. Fill Out the Correct License Form
•
IMPORTANT: You must fill out either a Real ID Driver’s License form or a Limited
Purpose Driver's License form, depending on your situation. These forms will include
the specific documentation and requirements you need to submit.
3. Purchase the Driver’s Manual ($20.00). Purchase the driver’s manual to help you prepare
for the Knowledge Skills Exam.
4. Schedule and Take the Knowledge Skills Exam ($20.00). Purchase and schedule the
Knowledge Skills Exam. A passing grade of 75% or higher is required to proceed.
5. Purchase the Learner’s Permit ($20.00). After passing the Knowledge Skills Exam,
purchase your Learner’s Permit, which will be valid for six (6) months.
6. Schedule and Take the Road Skills Exam ($20.00). Once you’ve completed all the above,
schedule and take the Road Skills Exam.
7. Obtain Your 5-Year Driver’s License ($55.00). After successfully passing the Road Skills
Exam, you will be issued a 5-year driver’s license for a fee of $55.00.
Online Appointments. You can now schedule your appointments online or by phone. To cancel an appointment, 
you must do so at least 48 hours in advance. Cancellations can be made by calling or visiting your nearest BMV 
office. 
For more information, please contact: 
BMV STX: (340)713-4268 | BMV STT: (340)774-4268 | BMV STJ: (340)776-6262 | or visit bmv.vi.gov