Form Msb 7 – Fill Out and Use This PDF

1.APPLICANT INFORMATION: (Only the registered owner of the motorcycle listed below may apply for the sticker.)

Name

		Last				First				MI
Mailing Address
City					State		Zip Code
Driver License #								State
Date of Birth

2.MOTORCYCLE INFORMATION: (Must be currently registered in Texas)

Make

Model Year

Vehicle ID Number

Texas License Plate Number

3.HEALTH INSURANCE: If your qualifier for the helmet exemption sticker is a health insurance plan, complete the following:

Insurance Co. Name

Insurance Policy #

Type Insurance (Individual policy, HMO, VA Card, etc.)

NOTE: Enclose a photocopy of your proof of health insurance. Vehicle liability insurance cards are not required.

4.MOTORCYCLE SAFETY COURSE

If your qualifier for the helmet exemption sticker is a motorcycle safety course, complete the following:

Course Completed (Check One)		Basic	Advanced
Course Completion Date
Completion Card Serial Number

If the course was taken outside of Texas or on a military base, where?

NOTE: Enclose a photocopy of your course completion card.

INCLUDE WITH YOUR APPLICATION:

•a non-refundable five-dollar ($5.00) cashier’s check or money order (cash or personal checks not accepted).

•a photocopy of your motorcycle’s registration or title.

•proof of course completion (MSB-8, Military or other completion

card)

OR

•proof of health insurance coverage (photocopy of health insurance card, certificate of insurance, or policy declaration page).

NOTE: Failure to enclose required documentation may result in application denial.

MAIL APPLICATION TO:

MOTORCYCLE SAFETY UNIT

TEXAS DEPARTMENT OF PUBLIC SAFETY

PO BOX 15999

AUSTIN, TEXAS 78761-5999

Walk-ins not accepted.

Texas Motorcycle Helmet Law.

Effective September 1, 1997, persons at least 21 years old are exempt from wearing a motorcycle helmet if they:

•have successfully completed a motorcycle safety course,

OR

•are covered by a health insurance plan providing at least $10,000 minimum in medical benefits for injuries incurred as a result of an accident.

Motorcycle Safety Course. The Basic and Advanced Motorcycle Operator Training Courses meet the helmet exemption requirement. The Advanced Motorcycle Operator Training Course is recommended for experienced licensed motorcyclists.

Health Insurance Plan. Defined as “ . . . an individual, group, blanket, or franchise insurance policy, insurance agreement, group hospital services contract, health maintenance organization membership, or employee benefit plan that provides benefits for health care services or for medical or surgical expenses incurred as a result of an accident.”

Helmet Exemption Sticker. The Department of Public Safety issues Helmet Exemption stickers to persons who:

•apply to the department on the form provided above;

•is the registered owner of the motorcycle listed on the application;

•provides adequate proof of successful completion of the Basic or Advanced Motorcycle Operator Training Course, or health insurance coverage, and,

•pay a $5.00 non-refundable fee for each sticker applied for.

Persons operating, or riding upon, a motorcycle with a helmet exemption sticker displayed on the license plate or license plate mounting bracket are presumed to meet the training or insurance requirements for riding without a helmet.

NOTE: Helmet Exemption stickers are serialized and may not be transferred from one motorcycle to another. The sticker expires on the third anniversary of their date of issuance.

Helmet Exemption Sticker Application Instructions.

•Complete the application in its entirety. The information must be typed or neatly printed.

•Once completed, detach the form and mail it to the address on the application.

INCLUDE WITH YOUR APPLICATION:

•a photocopy of your motorcycle’s registration or title.

•proof of course completion (MSB-8, Military or other completion card) OR proof of health insurance coverage (photocopy of health insurance card, certificate of insurance, or policy declaration page)

•a non-refundable five-dollar ($5.00) cashier’s check or money order (cash or personal checks not accepted)

•The cashier’s check or money order must be made out to the Texas Department of Public Safety.

NOTE: If the application is denied, the applicant will be informed of the reason. Applicants may reapply once the reason for denial is corrected.