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PROVISIONAL LICENSE SUPPLEMENTAL FORM Page 1 of 3 Division of Public and Behavioral Health 727 Fairview Drive, Suite E Carson City, Nevada 89701 Phone: (775) 684-1030 Fax: (775) 684-1073 Email: individual

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How to fill out provisional license supplemental form

How to fill out a provisional license supplemental form:

01

Obtain the form: The provisional license supplemental form is usually available on the website of your local department of motor vehicles (DMV) or can be picked up in-person at a DMV office.

02

Read the instructions: Before filling out the form, carefully read the instructions provided. These instructions will guide you through the process and ensure that you provide all the necessary information.

03

Personal information: Start by providing your personal details such as your full name, address, date of birth, and contact information. Make sure to double-check the accuracy of this information before moving on.

04

Provisional license information: You'll need to provide your current provisional license information, including the license number, date of issue, and expiration date. If you don't have a provisional license yet, you may need to submit a different form for obtaining one.

05

Reason for supplemental form: Specify the reason you are filling out the supplemental form. This may include circumstances such as a change of address, a name change, or updating your medical information. Be sure to explain the specific reason clearly and concisely.

06

Supporting documentation: Depending on the reason for filling out the form, you may need to attach supporting documentation. For example, if you are updating your medical information, you might need a doctor's note or medical certificate. Make sure to gather and include any required documents before submitting the form.

07

Signature and date: At the end of the form, you will be required to sign and date it. By doing so, you are confirming that all the information provided is true and accurate to the best of your knowledge.

Who needs a provisional license supplemental form?

01

Individuals with changes in personal information: If you have recently moved, changed your name, or experienced any other changes related to your personal information, you may need to fill out a provisional license supplemental form.

02

Applicants with updated medical information: If there have been any changes to your medical condition or if you need to update your medical information in relation to your provisional license, you will likely need to fill out this form.

03

Those requiring specific endorsements or restrictions: If you need to add or remove specific endorsements or restrictions from your provisional license, such as the ability to drive at night or in certain weather conditions, you may need to submit a provisional license supplemental form.

Remember, it's important to check with your local DMV or licensing authority to determine the specific requirements and procedures for filling out and submitting the provisional license supplemental form in your area.

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