ACORD 50 OK (2009/08)

Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 50 OK (2009/08)
Oklahoma Owners Security
Verification Form
ACORD 50 OK, Oklahoma Owners Security Verification Form, was
created in response to Oklahoma regulations. The main differences between the generic
ACORD Automobile Insurance Card, ACORD 50, and the Oklahoma card are:
* The company name and address is required
* The address of the insured cannot be shown on the card
* The front of the card includes a series of letters of the alphabet that correspond to pre-
printed coverages shown on the back of the card
* The appropriate letters must be checked or circled to indicate actual coverage in the
policy
* Excluded drivers should be listed on the front of the card
* The front of the OWNERS FORM states that a liability insurance policy has been issued
pursuant to the compulsory insurance law of Oklahoma, and that a copy this form must be
kept in the vehicle at all times. It also states that a copy of this form must be submitted
with an application for registration.
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* The back of the OWNERS FORM contains a statement describing Oklahoma state law
which requires that a copy of this form be produced upon request by a peace officer, or
representative of the Department of Public Safety or, in the case of a collision, other
persons affected by the collision
* The back of the card also states that a current copy of this form must be surrendered to
the motor vehicle license agent or other registering agency upon application or renewal for
a motor vehicle license plate
* Card must be issued in duplicate
IDENTIFICATION SECTION Check box - Commercial One
Check the box (if applicable): Indicates the policy is a commercial lines policy.
IDENTIFICATION SECTION Check box - Personal One
Check the box (if applicable): Indicates the policy is a personal lines policy.
ACORD 50 OK (2009/08) rev. 08-31-2009
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Section Name
Field Name
Field and/or Section Description
INSURANCE
IDENTIFICATION CARD
Company NAIC Number One
Enter code: The identification code assigned to the insurer by the NAIC.
INSURANCE
IDENTIFICATION CARD
Company One
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name.
INSURANCE
IDENTIFICATION CARD
Enter text: The first line of the insurer's mailing address.
INSURANCE
IDENTIFICATION CARD
Enter text: The city of the insurer's mailing address.
INSURANCE
IDENTIFICATION CARD
Enter code: The state or province of the insurer's mailing address.
INSURANCE
IDENTIFICATION CARD
Enter code: The postal code of the insurer's mailing address.
INSURANCE
IDENTIFICATION CARD
Policy Number One
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
referenced exactly as it appears on the policy, including prefix and suffix symbols. If
required for self-insurance, the self-insured license or contract number.
INSURANCE
IDENTIFICATION CARD
Effective Date One
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
INSURANCE
IDENTIFICATION CARD
Expiration Date One
Enter date: The date on which the terms and conditions of the policy will expire.
INSURANCE
IDENTIFICATION CARD
Year One
Enter year: The model year of the vehicle.
IDENTIFICATION SECTION Make One
Enter text: The manufacturer of the vehicle (e.g. Ford, Chevy).
IDENTIFICATION SECTION Model One
Enter text: The manufacturer's model name for the vehicle.
INSURANCE
IDENTIFICATION CARD
Vehicle Identification Number One
Enter identifier: The vehicle identification number (VIN) or serial number assigned by the
manufacturer.
INSURANCE
IDENTIFICATION CARD
Agency/Company Issuing Card
One
Enter text: The full name of the producer/agency.
INSURANCE
IDENTIFICATION CARD
Enter text: The mailing address line one of the producer/agency.
INSURANCE
IDENTIFICATION CARD
Enter text: The mailing address line two of the producer/agency.
INSURANCE
IDENTIFICATION CARD
Enter text: The mailing address city name of the producer/agency.
ACORD 50 OK (2009/08) rev. 08-31-2009
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Section Name
Field Name
Field and/or Section Description
INSURANCE
IDENTIFICATION CARD
Enter code: The mailing address state or province code of the producer/agency.
INSURANCE
IDENTIFICATION CARD
Enter code: The mailing address postal code of the producer/agency.
INSURANCE
IDENTIFICATION CARD
Enter number: The producer's contact person's phone number. If applicable, include the
area code and extension.
INSURANCE
IDENTIFICATION CARD
Insured One
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
INSURANCE
IDENTIFICATION CARD
Coverages A One
Check the box (if applicable): Indicates the vehicle has liability (bodily injury/property
damage) coverage.
INSURANCE
IDENTIFICATION CARD
Coverages C One
Check the box (if applicable): Indicates the vehicle has medical payments coverage.
INSURANCE
IDENTIFICATION CARD
Coverages D One
Check the box (if applicable): Indicates the vehicle has comprehensive coverage.
INSURANCE
IDENTIFICATION CARD
Coverages G One
Check the box (if applicable): Indicates the vehicle has collision coverage.
INSURANCE
IDENTIFICATION CARD
Coverages L One
Check the box (if applicable): Indicates the vehicle has loss to your recreational vehicle
coverage.
INSURANCE
IDENTIFICATION CARD
Coverages N One
Check the box (if applicable): Indicates the vehicle has emergency road service coverage.
INSURANCE
IDENTIFICATION CARD
Coverages R One
Check the box (if applicable): Indicates the vehicle has rental reimbursement coverage.
INSURANCENCE
Ch
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(if applicable): Indicates the vehicle has rental reimbursement and travel
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INSURA
IDENTIFICATION CARD
Coverages R1 One
Check the box (if
expense coverage.
INSURANCE
IDENTIFICATION CARD
Coverages U One
Check the box (if applicable): Indicates the vehicle has uninsured motorists coverage.
INSURANCE
IDENTIFICATION CARD
Coverages S One
Check the box (if applicable): Indicates the vehicle has death and dismemberment
coverage.
INSURANCE
IDENTIFICATION CARD
Coverages T One
Check the box (if applicable): Indicates the vehicle has disability coverage.
INSURANCE
IDENTIFICATION CARD
Coverages Z One
Check the box (if applicable): Indicates the vehicle has loss of earnings coverage.
INSURANCE
IDENTIFICATION CARD
Excluded Drivers One
Enter text: The driver's first name (given name). As used here, this is an excluded driver.
INSURANCE
IDENTIFICATION CARD
Enter text: The driver's middle name or initial (other given name). As used here, this is an
excluded driver.
ACORD 50 OK (2009/08) rev. 08-31-2009
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Section Name
Field Name
Field and/or Section Description
INSURANCE
IDENTIFICATION CARD
Enter text: The driver's last name (surname). As used here, this is an excluded driver.
INSURANCE
IDENTIFICATION CARD
Enter text: The driver's first name (given name). As used here, this is an excluded driver.
INSURANCE
IDENTIFICATION CARD
Enter text: The driver's middle name or initial (other given name). As used here, this is an
excluded driver.
INSURANCE
IDENTIFICATION CARD
Enter text: The driver's last name (surname). As used here, this is an excluded driver.
IDENTIFICATION SECTION Check box - Commercial Two
Check the box (if applicable): Indicates the policy is a commercial lines policy.
IDENTIFICATION SECTION Check box - Personal Two
Check the box (if applicable): Indicates the policy is a personal lines policy.
INSURANCE
IDENTIFICATION CARD
Company NAIC Number Two
Enter code: The identification code assigned to the insurer by the NAIC.
INSURANCE
IDENTIFICATION CARD
Company Two
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name.
INSURANCE
IDENTIFICATION CARD
Enter text: The first line of the insurer's mailing address.
INSURANCE
IDENTIFICATION CARD
Enter text: The city of the insurer's mailing address.
INSURANCE
C
OON CARD
C
E Enter code: The state or province of the insurer's mailing address.
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IDENTIFICATI
INSURANCE
IDENTIFICATION CARD
Enter code: The postal code of the insurer's mailing address.
INSURANCE
IDENTIFICATION CARD
Policy Number Two
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
referenced exactly as it appears on the policy, including prefix and suffix symbols. If
required for self-insurance, the self-insured license or contract number.
INSURANCE
IDENTIFICATION CARD
Effective Date Two
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
INSURANCE
IDENTIFICATION CARD
Expiration Date Two
Enter date: The date on which the terms and conditions of the policy will expire.
INSURANCE
IDENTIFICATION CARD
Year Two
Enter year: The model year of the vehicle.
IDENTIFICATION SECTION Make Two
Enter text: The manufacturer of the vehicle (e.g. Ford, Chevy).
ACORD 50 OK (2009/08) rev. 08-31-2009
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Section Name
Field Name
Field and/or Section Description
IDENTIFICATION SECTION Model Two
Enter text: The manufacturer's model name for the vehicle.
INSURANCE
IDENTIFICATION CARD
Vehicle Identification Number Two
Enter identifier: The vehicle identification number (VIN) or serial number assigned by the
manufacturer.
INSURANCE
IDENTIFICATION CARD
Agency/Company Issuing Card
Two
Enter text: The full name of the producer/agency.
INSURANCE
IDENTIFICATION CARD
Enter text: The mailing address line one of the producer/agency.
INSURANCE
IDENTIFICATION CARD
Enter text: The mailing address line two of the producer/agency.
INSURANCE
IDENTIFICATION CARD
Enter text: The mailing address city name of the producer/agency.
INSURANCE
IDENTIFICATION CARD
Enter code: The mailing address state or province code of the producer/agency.
INSURANCE
IDENTIFICATION CARD
Enter code: The mailing address postal code of the producer/agency.
INSURANCE
IDENTIFICATION CARD
Enter number: The producer's contact person's phone number. If applicable, include the
area code and extension.
INSURANCE
IDENTIFICATION CARD
Insured Two
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
INSURANCE
IDENTIFICATION CARD
Coverages A Two
Check the box (if applicable): Indicates the vehicle has liability (bodily injury/property
damage) coverage.
INSURANCENCE
INSURA
IDENTIFICATION CARD
Coverages C Two
Check the box (if applicable): Indicates the vehicle has medical payments coverage.
INSURANCE
IDENTIFICATION CARD
Coverages D Two
Check the box (if applicable): Indicates the vehicle has comprehensive coverage.
INSURANCE
IDENTIFICATION CARD
Coverages G Two
Check the box (if applicable): Indicates the vehicle has collision coverage.
INSURANCE
IDENTIFICATION CARD
Coverages L Two
Check the box (if applicable): Indicates the vehicle has loss to your recreational vehicle
coverage.
INSURANCE
IDENTIFICATION CARD
Coverages N Two
Check the box (if applicable): Indicates the vehicle has emergency road service coverage.
INSURANCE
IDENTIFICATION CARD
Coverages R Two
Check the box (if applicable): Indicates the vehicle has rental reimbursement coverage.
INSURANCE
IDENTIFICATION CARD
Coverages R1 Two
Check the box (if applicable): Indicates the vehicle has rental reimbursement and travel
expense coverage.
ACORD 50 OK (2009/08) rev. 08-31-2009
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Section Name
Field Name
Field and/or Section Description
INSURANCE
IDENTIFICATION CARD
Coverages U Two
Check the box (if applicable): Indicates the vehicle has uninsured motorists coverage.
INSURANCE
IDENTIFICATION CARD
Coverages S Two
Check the box (if applicable): Indicates the vehicle has death and dismemberment
coverage.
INSURANCE
IDENTIFICATION CARD
Coverages T Two
Check the box (if applicable): Indicates the vehicle has disability coverage.
INSURANCE
IDENTIFICATION CARD
Coverages Z Two
Check the box (if applicable): Indicates the vehicle has loss of earnings coverage.
INSURANCE
IDENTIFICATION CARD
Excluded Drivers Two
Enter text: The driver's first name (given name). As used here, this is an excluded driver.
INSURANCE
IDENTIFICATION CARD
Enter text: The driver's middle name or initial (other given name). As used here, this is an
excluded driver.
INSURANCE
IDENTIFICATION CARD
Enter text: The driver's last name (surname). As used here, this is an excluded driver.
INSURANCE
IDENTIFICATION CARD
Enter text: The driver's first name (given name). As used here, this is an excluded driver.
INSURANCE
IDENTIFICATION CARD
Enter text: The driver's middle name or initial (other given name). As used here, this is an
excluded driver.
INSURANCE
IDENTIFICATION CARD
Enter text: The driver's last name (surname). As used here, this is an excluded driver.
Edition
Date
The edition identifier of the form including the form number and edition (the date is
typically formatted YYYY/MM).
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