Statement of Facts Concerning a Minor and Certificate of Insurance Coverage

Adobe Acrobat Reader is required to view, fill out and print forms. To incorporate the latest accessibility features download of the latest version of Acrobat Reader may be required. If you have problems with Acrobat Reader or our PDF form, select PDF Troubleshooting.

This Statement of Facts is used when a student, whose parents are not California residents, wishes to obtain a student license and the school in California where the student resides will accept liability for the student driver. It is also used when a student is a foster child with no legal guardians.

Back to Main forms page