ACORD 50 MI (2010/08)

Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 50 MI (2010/08)
State of Michigan Certificate of No-
Fault Insurance
ACORD 50 MI, Michigan Certificate of No-Fault Insurance Card, was
created to satisfy Michigan statutory and regulatory requirements with respect to proof of
no-fault insurance coverage. There is space provided on the back of the certificate to list
excluded drivers. The part of ACORD 50 MI which includes the statement Secretary of
State Copy should be used by the insured to apply for vehicle registration. The other part
must be kept in the insured's vehicle at all times.
INSURANCE
IDENTIFICATION CARD
Check box - Commercial One
Check the box (if applicable): Indicates the policy is a commercial lines policy.
INSURANCE
IDENTIFICATION CARD
Check box - Personal One
Check the box (if applicable): Indicates the policy is a personal lines policy.
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
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.
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.
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
Insured 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.
ACORD 50 MI (2010/08) rev. 07-30-2010
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Section Name
Field Name
Field and/or Section Description
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.
INSURANCE
IDENTIFICATION CARD
Check box - Commercial Two
Check the box (if applicable): Indicates the policy is a commercial lines policy.
INSURANCE
IDENTIFICATION CARD
Check box - Personal Two
Check the box (if applicable): Indicates the policy is a personal lines policy.
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
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.
INSURANCE
IDENTIFICATION CARD
Make Two
Enter text: The manufacturer of the vehicle (e.g. Ford, Chevy).
INSURANCE
IDENTIFICATION CARD
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
Insured Two
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.
ACORD 50 MI (2010/08) rev. 07-30-2010
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Section Name
Field Name
Field and/or Section Description
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.
INSURANCE
IDENTIFICATION CARD
Check box - Commercial Three
Check the box (if applicable): Indicates the policy is a commercial lines policy.
INSURANCE
IDENTIFICATION CARD
Check box - Personal Three
Check the box (if applicable): Indicates the policy is a personal lines policy.
INSURANCE
IDENTIFICATION CARD
Company Three
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 Three
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 Three
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
INSURANCE
IDENTIFICATION CARD
Expiration Date Three
Enter date: The date on which the terms and conditions of the policy will expire.
INSURANCE
IDENTIFICATION CARD
Year Three
Enter year: The model year of the vehicle.
INSURANCE
IDENTIFICATION CARD
Make Three
Enter text: The manufacturer of the vehicle (e.g. Ford, Chevy).
INSURANCE
IDENTIFICATION CARD
Model Three
Enter text: The manufacturer's model name for the vehicle.
INSURANCE
IDENTIFICATION CARD
Vehicle Identification Number
Three
Enter identifier: The vehicle identification number (VIN) or serial number assigned by the
manufacturer.
INSURANCE
IDENTIFICATION CARD
Agency/Company Issuing Card
Three
Enter text: The full name of the producer/agency.
INSURANCE
IDENTIFICATION CARD
Insured Three
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.
ACORD 50 MI (2010/08) rev. 07-30-2010
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Section Name
Field Name
Field and/or Section Description
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.
INSURANCE
IDENTIFICATION CARD
Check box - Commercial Four
Check the box (if applicable): Indicates the policy is a commercial lines policy.
INSURANCE
IDENTIFICATION CARD
Check box - Personal Four
Check the box (if applicable): Indicates the policy is a personal lines policy.
INSURANCE
IDENTIFICATION CARD
Company Four
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 Four
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 Four
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
INSURANCE
IDENTIFICATION CARD
Expiration Date Four
Enter date: The date on which the terms and conditions of the policy will expire.
INSURANCE
IDENTIFICATION CARD
Year Four
Enter year: The model year of the vehicle.
INSURANCE
IDENTIFICATION CARD
Make Four
Enter text: The manufacturer of the vehicle (e.g. Ford, Chevy).
INSURANCE
IDENTIFICATION CARD
Model Four
Enter text: The manufacturer's model name for the vehicle.
INSURANCE
IDENTIFICATION CARD
Vehicle Identification Number Four
Enter identifier: The vehicle identification number (VIN) or serial number assigned by the
manufacturer.
INSURANCE
IDENTIFICATION CARD
Agency/Company Issuing Card
Four
Enter text: The full name of the producer/agency.
INSURANCE
IDENTIFICATION CARD
Insured Four
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.
ACORD 50 MI (2010/08) rev. 07-30-2010
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Section Name
Field Name
Field and/or Section Description
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.
INSURANCE
IDENTIFICATION CARD
Excluded Drivers
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
Excluded Drivers
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
Excluded Drivers
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
Excluded Drivers
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
Excluded Drivers
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.
ACORD 50 MI (2010/08) rev. 07-30-2010
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Section Name
Field Name
Field and/or Section Description
INSURANCE
IDENTIFICATION CARD
Excluded Drivers
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
Excluded Drivers
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
Excluded Drivers
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
Check box - Commercial One
Check the box (if applicable): Indicates the policy is a commercial lines policy.
INSURANCE
IDENTIFICATION CARD
Check box - Personal One
Check the box (if applicable): Indicates the policy is a personal lines policy.
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
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.
INSURANCE
IDENTIFICATION CARD
Make One
Enter text: The manufacturer of the vehicle (e.g. Ford, Chevy).
ACORD 50 MI (2010/08) rev. 07-30-2010
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Section Name
Field Name
Field and/or Section Description
INSURANCE
IDENTIFICATION CARD
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
Insured 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.
INSURANCE
IDENTIFICATION CARD
Excluded Drivers
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
Excluded Drivers
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
Check box - Commercial Two
Check the box (if applicable): Indicates the policy is a commercial lines policy.
INSURANCE
IDENTIFICATION CARD
Check box - Personal Two
Check the box (if applicable): Indicates the policy is a personal lines policy.
ACORD 50 MI (2010/08) rev. 07-30-2010
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Section Name
Field Name
Field and/or Section Description
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
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.
INSURANCE
IDENTIFICATION CARD
Make Two
Enter text: The manufacturer of the vehicle (e.g. Ford, Chevy).
INSURANCE
IDENTIFICATION CARD
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
Insured Two
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.
INSURANCE
IDENTIFICATION CARD
Excluded Drivers
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 MI (2010/08) rev. 07-30-2010
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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
Excluded Drivers
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).
ACORD 50 MI (2010/08) rev. 07-30-2010
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