Mail to: Medical Affairs, PO Box 55889, Boston, MA 02205-5889 857-368-8020 mass-2026

1. Click ‘Get Form’ to open the application in the editor.
2. Begin by filling out Section A with the disabled applicant's information. Include their last name, first name, date of birth, and Social Security number. Ensure that the residential address is accurate.
3. In Section B, select the type of service you are applying for: Placard, Plate, Motorcycle Plate, or DV Plate. Make sure to read any applicable notes regarding fees and eligibility.
4. Proceed to Section C where both the disabled person and healthcare provider must sign and date the application. Review all rules carefully before signing.
5. If applicable, complete Section D with healthcare provider information. The provider must certify the medical condition and provide their signature in Section E.
6. Once all sections are completed accurately, save your document and submit it to Medical Affairs within thirty days of certification.

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