ACORD 50 PA (2007/09)

Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 50 PA (2007/09)
Pennsylvania Financial
Responsibility Identification Card
ACORD 50 PA, Pennsylvania Financial Responsibility Identification
Card, was created in response to a new Pennsylvania law. The main differences between
the generic ACORD Automobile Insurance Card, ACORD 50, and the Pennsylvania card
are:
* Statement indicating card is not valid for more than one (1) year from the effective date
is on the front of the form
* A state mandated warning to the owner/registrant regarding required financial
responsibility and the negative consequences of non-compliance is on the reverse side of
the form
* Requirements for the presentation of the card are included on the reverse side of the
form
INSURANCE
IDENTIFICATION CARD
Commercial (checkbox) One
Check the box (if applicable): Indicates the policy is a commercial lines policy.
INSURANCE
IDENTIFICATION CARD
Personal (checkbox) One
Check the box (if applicable): Indicates the policy is a personal lines policy.
INSURANCE
IDENTIFICATION CARD
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
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
Year One
Enter year: The model year of the vehicle.
INSURANCE
IDENTIFICATION CARD
Make One
Enter text: The manufacturer of the vehicle (e.g. Ford, Chevy).
INSURANCE
IDENTIFICATION CARD
Model One
Enter text: The manufacturer's model name for the vehicle.
Universal wording updates to improve clarity and intent were made to all FIG text for this form on 01/30/2009.
ACORD 50 PA (2007/09)
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Section Name
Field Name
Field and/or Section Description
Universal wording updates to improve clarity and intent were made to all FIG text for this form on 01/30/2009.
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
Agency/Company Telephone
Number One
Enter number: The producer's contact person's phone number. If applicable, include the
area code and extension.
INSURANCE
IDENTIFICATION CARD
Insured Name And Address One
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
INSURANCE
IDENTIFICATION CARD
Enter text: The named insured's mailing address line one.
INSURANCE
IDENTIFICATION CARD
Enter text: The named insured's mailing address line two.
INSURANCE
IDENTIFICATION CARD
Enter text: The named insured's mailing address city name.
INSURANCE
IDENTIFICATION CARD
Enter code: The named insured's mailing address state or province code.
INSURANCE
IDENTIFICATION CARD
Enter code: The named insured's mailing address postal code.
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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