STATE OF DELAWARE
DEPARTMENT OF TRANSPORTATION
DIVISION OF MOTOR VEHICLES
APPLICATION FOR MEDICAL TINT WAIVER

Instructions

To apply for a Medical Tint Waiver, please fill out this electronic form. A red asterisk next to a field represents a required field. You may select to apply for a NEW Medical Tint Waiver or request to add a new or additional vehicle(s) to an existing approved Medical Tint Waiver. All vehicles must be titled in the State of Delaware and have received a valid registration card.

Windshields are not permitted to be tinted below the AS-1 line.

Please fill out all sections. This electronic form will require your electronic signature. Please follow the instructions in order to properly apply your electronic signature. Once all sections have been completed, please press the submit button. After pressing the submit button, an email will be generated and sent to the email address entered.

If this is a new Medical Tint Waiver request, the email will include an attached Medical Tint Waiver form that has been filled out for you based on the information you provided. This form is required to be certified by your doctor. Once you receive the email, open the attached PDF document and print the attached Medical Tint Waiver. Have your doctor fill out the rest of the application.

Once it has been filled out and signed by your doctor, please use a scanner and scan all pages of your completed Tint Waiver, creating one PDF file. Please use the link in the email titled "Submit Completed Tint Waiver" you just received to upload your scanned PDF file and submit your completed Tint Waiver to DMV. The form will also require you to enter the data found on your completed Tint Waiver for the following fields:

Doctor's Phone Number
Doctor's Address
Doctor's Medical License ID
Doctor's Date of Signature
Medical Condition

An email will be sent to DMV to review your request for a new Tint Waiver. If everything you have submitted is accurate and all required information is included in the Tint Waiver request, DMV will approve your Tint Waiver and make the necessary tint waiver change in the DMV system for the vehicle(s) listed. Once completed, you will be notified by email. DMV will mail you a new Tint Waiver form for this vehicle and a new registration card reflecting the Tint Waiver. It is required that both of these items are present in your new vehicle.

If the information is not complete or inaccurate, your request will be denied and you will receive an email denying your request.

This waiver must be in the registered owner's name or the name of the usual operator of the vehicle. Waivers are valid as long as the individual owns the vehicle or the individual is the usual operator of the vehicle for which the waiver has been approved. When the individual acquires a new vehicle or misplaces the form, a new waiver form must be completed, certified by a physician, and approved by DMV.

If this is to add a new vehicle or add additional vehicles to an existing approved Medical Tint Waiver, enter all required information and press submit. Once an associate reviews and approves the request, an email confirmation will be sent. A new registration card and a sealed Medical Tint Waiver will be mailed to the address on record.

If Medical Tint Waiver is for someone other than the registered owner of the vehicle, an Initial / New Medical Tint Wavier Request must be selected.

Tint Waiver Request v2 Prod

APPLICATION FOR MEDICAL TINT WAIVER

Complete the application (applicants first and last name) for Medical Tint Waiver in the registered owner's name or the name of person whom the Medical Exemption request is for; the usual operator/passenger of the vehicle living within the same household. Waivers are valid as long as the individual owns the vehicle, or the individual is the usual operator/passenger of the vehicle living within the same household for which the waiver has been approved. When the individual acquires a new or additional vehicles (up to three more) or misplaces the form, an electronic request must be submitted to the DMV.

If approved, the Medical Tint Waiver is valid within the State of Delaware. If you travel interstate, or outside of Delaware, you must follow the laws of that particular state. If you need additional guidance, it is recommended you contact the state(s) in which you will be traveling.

If the above statement is true, please enter the applicant's First Name, Last Name, and Email Address. Please answer the additional questions.

Error Message

Tint Waiver Applicant's First Name Enter the First Name of the Person Requesting the Tint Waiver

Tint Waiver Applicant's Last Name Enter the Last Name of the Person Requesting the Tint Waiver

Applicant's eMail Address The Email Address Entered Will Be Used For All DMV Notifications

Vehicles For Tint Waiver Titled In Delaware? All Vehicles Being Requested For A Tint Waiver Must Be Currently Titled In Delaware

Yes

No

Tint Waiver Type

Please answer the following questions

Tint Waiver Type Please select Tint Waiver Type, New or Existing

Initial/New Tint Waiver Request

Add New/Additional Vehicle(s) to An Existing Approved Tint Waiver

Number of New/Existing Registered Vehicles Select the Number of New/Existing Registered Vehicles That the Tint Waiver Will Be Applied To

1

2

3

4

Medical Exemption Request Is the Tint Waiver Request for Someone Other Than The Registered Owner of the Vehicle?

Yes

No

Delaware DL or Delaware ID Does this Tint Waiver Applicant Have A Delaware Driver's License or ID Card?

Yes

No

Medical Exemption Who is NOT the Vehicle's Registered Owner

Please Enter the Following Information for the Person Receiving the Medical Exemption Who is NOT the Registered Owner of the Vehicle. This Tint Waiver Request Must Be in the Care Of the Vehicle Owner.

DE Driver's License or ID Card Enter the DE License or ID Card of the Applicant

Date of Birth Enter the Date of Birth of the Tint Waiver Applicant

Vehicle Owner Information

Please Enter the Owner's Name and Address as Found on The Registration Card.

For Company Owned Vehicles, Enter the Vehicle Owner’s Company Name Field ONLY.

Error Message Owner

Vehicle Owner's Company Name

OR

Vehicle Owner First Name The Vehicle Owners First Name must be same exact First Name or Company as what appears on the Registration Card

Vehicle Owner Last Name The Vehicle Owners Last Name must be same exact Last Name as what appears on the Registration Card

Temp Company Name

Temp First Name

Temp Last Name

Full Name of Vehicle Owner

Address 1 Must be same Address First Line as what appears on the Registration Card

Address 2 Must be the same Address Second Line as what appears on Registration Card

City Must be same City as what appears on the Registration Card

State Must be same State as what appears on the Registration Card

Zip Must be same Zip Code as what appears on the Registration Card

Existing Tint Waiver Vehicle Information

Please Enter The Vehicle Information As Found On The Registration Card For The Vehicle On The Current Tint Waiver And Enter The Doctor's Name and Medical License ID Number Found On The Current Tint Waiver.

Existing Medical Tint Waiver Vehicle Tag Must be the same Tag Number as what appears on the Registration Card

Tint Waiver Vehicle VIN Vehicle Identification Number - Must be the same VIN as what appears on the Registration Card. VINs that contain O must always be entered as a 0 (zero).

Tint Waiver Vehicle Manufacturer Must be same Make as what appears on the Registration Card

Tint Waiver Vehicle Year Must be same Model Year as what appears on the Registration Card

Name of Doctor

Doctor's Medical License ID No:

Vehicle 1 Information

Please Enter the Vehicle Information as Found On The Registration Card

New Vehicle 1 Tag Must be the same Tag Number as what appears on the Registration Card

Vehicle 1 VIN Vehicle Identification Number - Must be the same VIN as what appears on the Registration Card. VINs that contain O must always be entered as a 0 (zero).

Vehicle 1 Manufacturer Must be same Make as what appears on the Registration Card

Vehicle 1 Year Must be same Model Year as what appears on the Registration Card

Vehicle 2 Information

Please Enter the Vehicle Information as Found On The Registration Card

New Vehicle 2 Tag Must be the same Tag Number as what appears on the Registration Card

Vehicle 2 VIN Vehicle Identification Number - Must be the same VIN as what appears on the Registration Card. VINs that contain O must always be entered as a 0 (zero).

Vehicle 2 Manufacturer Must be same Make as what appears on the Registration Card

Vehicle 2 Year Must be same Model Year as what appears on the Registration Card

Vehicle 3 Information

Please Enter the Vehicle Information as Found On The Registration Card

New Vehicle 3 Tag Must be the same Tag Number as what appears on the Registration Card

Vehicle 3 VIN Vehicle Identification Number - Must be the same VIN as what appears on the Registration Card. VINs that contain O must always be entered as a 0 (zero).

Vehicle 3 Manufacturer Must be same Make as what appears on the Registration Card

Vehicle 3 Year Must be same Model Year as what appears on the Registration Card

Vehicle 4 Information

Please Enter the Vehicle Information as Found On The Registration Card

New Vehicle 4 Tag Must be the same Tag Number as what appears on the Registration Card

Vehicle 4 VIN Vehicle Identification Number - Must be the same VIN as what appears on the Registration Card. VINs that contain O must always be entered as a 0 (zero).

Vehicle 4 Manufacturer Must be same Make as what appears on the Registration Card

Vehicle 4 Year Must be same Model Year as what appears on the Registration Card

Doctor's Information

Please enter the physician's Information.

If you do not know your physician's information, please leave it blank.

Physician's Full Name

Physician's eMail Address

Physician's Phone #

Signature

I am applying for a Medical Tint Waiver as specified by Section 4313 of Title 21 of the Delaware Code. I understand that the waiver is only valid for the State of Delaware and must be kept in the vehicle. I certify, under penalty of law, that the information supplied is true and correct.

Please Provide Your Signature

Please select "Type", "Draw", or "Upload" to provide your signature. If you select "Type", please use your keyboard, and type your full name in the box labeled "Signer's Name". If you select "Draw", please take your cursor, and place it next to the box with the "x". Hold your left mouse button down and begin to draw your name. At any time, you can select the "Clear" button to start over. If you select "Upload", please locate your signature on your computer, select the file that contains your signature, and select "Open".

Date of Birth Reformat

Doctor's Address 1

Doctor's Telephone Number

Doctor's Date Signed

Doctor's Signature

Medical Reason 1

Medical Reason 2

DMV Approval

DMV Signed

Reformat Owners First Name

Reformat Owners Last Name

Reformat Address 1

Reformat Address 2

Reformat City

Reformat First Name

Reformat Last Name

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VIN All Caps 1

VIN All Caps 2

VIN All Caps 3

VIN All Caps 4

Manufacturer All Caps 1

Manufacturer All Caps 2

Manufacturer All Caps 3

Manufacturer All Caps 4

Data Error

Data Error 2

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Data Error 4

Clear Error Message

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Tint Waiver Last Name First Name

Error Code

Error Message 2

Valid

Initials

Thank You Message Placeholder 1

Thank You Message Placeholder 2

Thank You Message Placeholder 3

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Tint Waiver Request