ACORD 54 (1/97)

Universal wording updates to improve clarity and intent were made to all FIG text for this form on 09/04/2009.
Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 54 (1/97)
Financial Responsibility Form
ACORD 54, Financial Responsibility Form, is used for certification of
liability insurance coverage for the future that is a basic element in all financial
responsibility laws. In order to reinstate a driving privilege after a driver license
suspension, an insurance company is called upon to certify liability coverage for the future,
usually three years, for the affected individual.
While the basic certification concept is for the most part rather uniform among the states
having financial responsibility laws, there are a number of procedural variations. The
Insurance Industry Committee on Motor Vehicle Administration (IICMVA) produces a
Financial Responsibility Programs and Procedures Guide that provides details about
specific procedures for each state. Information in this Guide relating to financial
responsibility was taken from the IICMVA publication in use as of the printing date of this
Guide. ACORD Form 54 is the basic form used in most states to certify insurance
coverage to the motor vehicle administrator when an insurance company files a
certification. It is the same as the American Association of Motor Vehicle Administrators
(AAMVA) form SR 22. When an insurance company files a certification, it is on the risk
until it files a cancellation notice.
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Field Name
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ACORD 54 cannot be used in Illinois, Minnesota and Vermont. Special state forms are
required. These forms have not been developed by ACORD.
The following states have no financial responsibility requirements that utilize forms such
as ACORD 54:
- Kentucky
- Maryland
- Massachusetts
- New Jersey
- New Mexico
- New York
- North Carolina
- Pennsylvania
- West Virginia
IDENTIFICATION SECTION Last
Enter text: The named insured's surname.
IDENTIFICATION SECTION First
Enter text: The named insured's given name.
IDENTIFICATION SECTION Middle
Enter text: The named insured's other given name initial.
IDENTIFICATION SECTION Address
Enter text: The named insured's mailing address line one.
IDENTIFICATION SECTION
Enter text: The named insured's mailing address city name.
IDENTIFICATION SECTION
Enter code: The named insured's mailing address state or province code.
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Section Name
Field Name
Field and/or Section Description
IDENTIFICATION SECTION
Enter code: The named insured's mailing address postal code.
IDENTIFICATION SECTION Case Number
Enter identifier: The financial responsibility filing case or file number.
IDENTIFICATION SECTION Driver's License Number
Enter identifier: The driver's license number.
IDENTIFICATION SECTION Birth Date
Enter date: The birth date of the driver.
IDENTIFICATION SECTION Social Security Number
Enter identifier: The tax identifier (social security number) of the driver.
IDENTIFICATION SECTION Current Policy #
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.
IDENTIFICATION SECTION Effective From
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
IDENTIFICATION SECTION Certification Effective From
Enter date: The date on which the financial responsibility certification is effective.
IDENTIFICATION SECTION Owner's Policy
Check the box (if applicable): Indicates the type of filing is owner's (operation of owned
vehicles).
IDENTIFICATION SECTION Model Year
Enter year: The model year of the vehicle.
IDENTIFICATION SECTION Trade Name
Enter text: The manufacturer's model name for the vehicle.
IDENTIFICATION SECTION Identification Number
Enter identifier: The vehicle identification number (VIN) or serial number assigned by the
manufacturer.
IDENTIFICATION SECTION Model Year
Enter year: The model year of the vehicle.
IDENTIFICATION SECTION Trade Name
Enter text: The manufacturer's model name for the vehicle.
IDENTIFICATION SECTION Identification Number
Enter identifier: The vehicle identification number (VIN) or serial number assigned by the
manufacturer.
IDENTIFICATION SECTION Operator's Policy
Check the box (if applicable): Indicates the type of filing is operator's (operation of non-
owned vehicles).
IDENTIFICATION SECTION State
Enter code: The state or province where the financial responsibility filing is required.
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Section Name
Field Name
Field and/or Section Description
IDENTIFICATION SECTION Company
Code # and Name of Insurance
Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION
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.
SIGNATURE SECTIONS
Date
Enter date: The date the producer signed the form.
SIGNATURE SECTIONS
By
Sign here: Accommodates the signature of the authorized representative (e.g. producer,
agent, broker, etc.). by all companies to issue Certificates. This is required in most states.
INSURANCE COMPANY
Name and Address of Insurance
Company
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 COMPANY
Enter text: The first line of the insurer's mailing address.
INSURANCE COMPANY
Enter text: The second line of the insurer's mailing address.
INSURANCE COMPANY
Enter text: The city of the insurer's mailing address.
INSURANCE COMPANY
Enter code: The state or province of the insurer's mailing address.
INSURANCE COMPANY
Enter code: The postal code of the insurer's mailing address.
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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