The Occupational Limited License Affidavit required under 75 Pa.C.S. § 1553(f)(5) (relating to occupational limited license) to be carried by a driver who has been issued an occupational limited license must include:

1. (1) The name, address, date of birth and driver license number of the petitioner.
2. (2) The year, make, model, license plate number and state of registration of every vehicle that will be driven by the petitioner.
3. (3) The insurance company name, policy number, effective date and expiration date of each insurance policy on every vehicle listed as being driven by the petitioner.
4. (4) The place of employment, study or medical treatment or appointment for which the occupational limited license is needed.
5. (5) The hours of operation necessary for travel to the employment, study or medical treatment or appointment.
6. (6) The name, signature and position of the employer, school administrator or medical provider attesting that the information provided on the form is true and correct.

Authority

The provisions of this § 86.103 issued under the Vehicle Code, 75 Pa.C.S. § § 1553 and 6103.

Source

The provisions of this § 86.103 adopted March 10, 2006, effective March 11, 2006, 36 Pa.B. 1128.