BMV FORM NO. (2019-07) – REV. Apr. 2-2019 
GOVERN
GOVERN
GOVERN
GOVERNMENT OF THE VIRGIN ISLANDS 
MENT OF THE VIRGIN ISLANDS 
MENT OF THE VIRGIN ISLANDS 
MENT OF THE VIRGIN ISLANDS  
OF THE UNITED STATES
OF THE UNITED STATES
OF THE UNITED STATES
OF THE UNITED STATES 
OFFICE OF THE GOVERNOR
OFFICE OF THE GOVERNOR
OFFICE OF THE GOVERNOR
OFFICE OF THE GOVERNOR 
BUREAU OF MOTOR VEHICLES
BUREAU OF MOTOR VEHICLES
BUREAU OF MOTOR VEHICLES
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
SIGN