BMV FORM NO. (2019-07) – REV. Jun. 24-2020 
GOVERNMENT OF THE VIRGIN ISLANDS 
OF THE UNITED STATES 
OFFICE OF THE GOVERNOR 
BUREAU OF MOTOR VEHICLES 
 
 
WAIVER FOR PREGNANT PERSONS 
 TAKING THE PRACTICAL ROAD TEST 
 
I._______________________________of______________________________________. 
Hereby confirm to the Bureau of Motor Vehicles that even though I am Pregnant, I have been 
advised by my attending physician Dr._________________________________________ 
That my condition and present state of health are good, and such that I should be permitted to 
take the practical examination for the operator’s license.  I will hold the Bureau of Motor 
Vehicles harmless from any/all Liability for permitting me to take this test in my present 
condition, should anything happen to me as a result of my operating a motor vehicle during this 
testing period. 
 
(Certified Physician) Signature:________________________ License #________________ 
 
Applicant’s Signature:________________________________Date____________________ 
 
This_______day of __________________ 
_________________________________ 
Notary  
 
Motor Vehicles Inspector:____________________________ Date of Exam_____________ 
SIGN
SIGN