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ACORD Form 50 PA Pennsylvania Financial Responsibility Identification Card Instructions
 

 
Universal wording updates to improve clarity and intent were made to all FIG text for this form on 01/30/2009.
Section Name Field Name Field and/or Section Description
TITLE ACORD 50 PA (2007/09) Pennsylvania Financial Responsibility Identification Card The title of the form. 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.

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Universal wording updates to improve clarity and intent were made to all FIG text for this form on 01/30/2009.
Section Name Field Name Field and/or Section Description
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).