391.65—Drivers furnished by other motor carriers.

(Name of driver)
(SS No.)
(Signature of driver)
I certify that the above named driver, as defined in § 390.5 is regularly driving a commercial motor vehicle operated by the below named carrier and is fully qualified under part 391, Federal Motor Carrier Safety Regulations. His/her current medical examiner's certificate expires on ____ (Date)
This certificate expires:
(Date not later than expiration date of medical certificate)
Issued on ____ (date)
Issued by __________
(Name of carrier)
(Address)
(Signature)
(Title)
[41 FR 36656, Aug. 31, 1976, as amended at 53 FR 18057, May 19, 1988; 60 FR 38745, July 28, 1995; 63 FR 33278, June 18, 1998; 67 FR 61824, Oct. 2, 2002]