ACORD 50 LA (2008/03)r - LOUISIANA AUTO INSURANCE IDENTIFICATION CARD

ACORD 50 LA (2008/03)r - LOUISIANA AUTO INSURANCE IDENTIFICATION CARD
ACORD 50 LA, Louisiana Auto Insurance Identification Card, was created in response to Louisiana regulations. The main differences between the
generic ACORD Automobile Insurance Card, ACORD 50, and the Louisiana card are:
* The company NAIC number and name and address must be shown on the front of the card.
* The explanation of penalties for failure to comply with statutes and regulations is revised.
* A statement is added to the front of the card referencing an authorized insurer who has issued a motor vehicle policy with coverage that meets
the minimum liability limits prescribed by law.
* The back of the form contains an Important Notice, required by regulation, that explains Louisiana compulsory insurance requirements, and the
possible penalties for failing to comply.
* The name, address and telephone number of the insurance agent, and a list of any excluded drivers, must appear on the back of the form.
* Two cards must be issued to the insured; one to be retained in the insured vehicle, and the second to provide proof of insurance at the time
license plates are purchased.
Form Page 1
Section Name
Field Name
Description
IDENTIFICATION SECTION
Commercial Checkbox One
Check the box (if applicable): Indicates the policy is a commercial lines policy.
IDENTIFICATION SECTION
Personal Checkbox One
Check the box (if applicable): Indicates the policy is a personal lines policy.
IDENTIFICATION SECTION
Company NAIC Number One
Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION
Company Affording
Coverage (Name and
Address) 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.
IDENTIFICATION SECTION
Enter text: The first line of the insurer's mailing address.
IDENTIFICATION SECTION
Enter text: The second line of the insurer's mailing address.
IDENTIFICATION SECTION
Enter text: The city of the insurer's mailing address.
IDENTIFICATION SECTION
Enter code: The state or province code of the insurer's mailing address.
IDENTIFICATION SECTION
Enter code: The postal code of the insurer's mailing address.
IDENTIFICATION SECTION
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.
ACORD 50 LA (2008/03)r rev. 06-04-2014
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IDENTIFICATION SECTION
Effective Date One
Enter date: The effective date of the policy. The date that the terms and conditions of the policy
commence. (MM/DD/YYYY)
IDENTIFICATION SECTION
Expiration Date One
Enter date: The date on which the terms and conditions of the policy will expire. (MM/DD/YYYY)
IDENTIFICATION SECTION
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.
IDENTIFICATION SECTION
Vehicle Identification
Number One
Enter identifier: The vehicle identification number (VIN) or serial number assigned by the
manufacturer.
IDENTIFICATION SECTION
Name of Insured One
Enter text: The named insured(s) as it / they will appear on the policy declarations page.
IDENTIFICATION SECTION
Commercial Checkbox One
Check the box (if applicable): Indicates the policy is a commercial lines policy.
IDENTIFICATION SECTION
Personal Checkbox One
Check the box (if applicable): Indicates the policy is a personal lines policy.
IDENTIFICATION SECTION
Company NAIC Number One
Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION
Company Affording
Coverage (Name and
Address) 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.
IDENTIFICATION SECTION
Enter text: The first line of the insurer's mailing address.
IDENTIFICATION SECTION
Enter text: The second line of the insurer's mailing address.
IDENTIFICATION SECTION
Enter text: The city of the insurer's mailing address.
IDENTIFICATION SECTION
Enter code: The state or province code of the insurer's mailing address.
IDENTIFICATION SECTION
Enter code: The postal code of the insurer's mailing address.
IDENTIFICATION SECTION
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.
IDENTIFICATION SECTION
Effective Date One
Enter date: The effective date of the policy. The date that the terms and conditions of the policy
commence. (MM/DD/YYYY)
IDENTIFICATION SECTION
Expiration Date One
Enter date: The date on which the terms and conditions of the policy will expire. (MM/DD/YYYY)
IDENTIFICATION SECTION
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.
ACORD 50 LA (2008/03)r rev. 06-04-2014
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IDENTIFICATION SECTION
Vehicle Identification
Number One
Enter identifier: The vehicle identification number (VIN) or serial number assigned by the
manufacturer.
IDENTIFICATION SECTION
Name of Insured One
Enter text: The named insured(s) as it / they will appear on the policy declarations page.
IDENTIFICATION SECTION
Commercial Checkbox Two
Check the box (if applicable): Indicates the policy is a commercial lines policy.
IDENTIFICATION SECTION
Personal Checkbox Two
Check the box (if applicable): Indicates the policy is a personal lines policy.
IDENTIFICATION SECTION
Company NAIC Number Two
Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION
Company Affording
Coverage (Name and
Address) 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.
IDENTIFICATION SECTION
Enter text: The first line of the insurer's mailing address.
IDENTIFICATION SECTION
Enter text: The second line of the insurer's mailing address.
IDENTIFICATION SECTION
Enter text: The city of the insurer's mailing address.
IDENTIFICATION SECTION
Enter code: The state or province code of the insurer's mailing address.
IDENTIFICATION SECTION
Enter code: The postal code of the insurer's mailing address.
IDENTIFICATION SECTION
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.
IDENTIFICATION SECTION
Effective Date Two
Enter date: The effective date of the policy. The date that the terms and conditions of the policy
commence. (MM/DD/YYYY)
IDENTIFICATION SECTION
Expiration Date Two
Enter date: The date on which the terms and conditions of the policy will expire. (MM/DD/YYYY)
IDENTIFICATION SECTION
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).
IDENTIFICATION SECTION
Model Two
Enter text: The manufacturer's model name for the vehicle.
IDENTIFICATION SECTION
Vehicle Identification
Number Two
Enter identifier: The vehicle identification number (VIN) or serial number assigned by the
manufacturer.
IDENTIFICATION SECTION
Name of Insured Two
Enter text: The named insured(s) as it / they will appear on the policy declarations page.
IDENTIFICATION SECTION
Commercial Checkbox Two
Check the box (if applicable): Indicates the policy is a commercial lines policy.
IDENTIFICATION SECTION
Personal Checkbox Two
Check the box (if applicable): Indicates the policy is a personal lines policy.
IDENTIFICATION SECTION
Company NAIC Number Two
Enter code: The identification code assigned to the insurer by the NAIC.
ACORD 50 LA (2008/03)r rev. 06-04-2014
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IDENTIFICATION SECTION
Company Affording
Coverage (Name and
Address) 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.
IDENTIFICATION SECTION
Enter text: The first line of the insurer's mailing address.
IDENTIFICATION SECTION
Enter text: The second line of the insurer's mailing address.
IDENTIFICATION SECTION
Enter text: The city of the insurer's mailing address.
IDENTIFICATION SECTION
Enter code: The state or province code of the insurer's mailing address.
IDENTIFICATION SECTION
Enter code: The postal code of the insurer's mailing address.
IDENTIFICATION SECTION
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.
IDENTIFICATION SECTION
Effective Date Two
Enter date: The effective date of the policy. The date that the terms and conditions of the policy
commence. (MM/DD/YYYY)
IDENTIFICATION SECTION
Expiration Date Two
Enter date: The date on which the terms and conditions of the policy will expire. (MM/DD/YYYY)
IDENTIFICATION SECTION
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).
IDENTIFICATION SECTION
Model Two
Enter text: The manufacturer's model name for the vehicle.
IDENTIFICATION SECTION
Vehicle Identification
Number Two
Enter identifier: The vehicle identification number (VIN) or serial number assigned by the
manufacturer.
IDENTIFICATION SECTION
Name of Insured Two
Enter text: The named insured(s) as it / they will appear on the policy declarations page.
Form Page 2
Section Name
Field Name
Description
IDENTIFICATION SECTION
Insurance Agent (Name,
Address, & Telephone
Number) One
Enter text: The full name of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address line one of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address line two of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address city name of the producer / agency.
IDENTIFICATION SECTION
Enter code: The mailing address state or province code of the producer / agency.
ACORD 50 LA (2008/03)r rev. 06-04-2014
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IDENTIFICATION SECTION
Enter code: The mailing address postal code of the producer / agency.
IDENTIFICATION SECTION
Enter number: The producer's contact person's phone number. If applicable, include the area
code and extension.
IDENTIFICATION SECTION
Excluded Drivers One
Enter text: The excluded driver's first name (given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's middle name or initial (other given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's last name (surname).
IDENTIFICATION SECTION
Enter text: The excluded driver's first name (given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's middle name or initial (other given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's last name (surname).
IDENTIFICATION SECTION
Insurance Agent (Name,
Address, & Telephone
Number) One
Enter text: The full name of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address line one of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address line two of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address city name of the producer / agency.
IDENTIFICATION SECTION
Enter code: The mailing address state or province code of the producer / agency.
IDENTIFICATION SECTION
Enter code: The mailing address postal code of the producer / agency.
IDENTIFICATION SECTION
Enter number: The producer's contact person's phone number. If applicable, include the area
code and extension.
IDENTIFICATION SECTION
Excluded Drivers One
Enter text: The excluded driver's first name (given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's middle name or initial (other given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's last name (surname).
IDENTIFICATION SECTION
Enter text: The excluded driver's first name (given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's middle name or initial (other given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's last name (surname).
IDENTIFICATION SECTION
Insurance Agent (Name,
Address, & Telephone
Number) Two
Enter text: The full name of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address line one of the producer / agency.
ACORD 50 LA (2008/03)r rev. 06-04-2014
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IDENTIFICATION SECTION
Enter text: The mailing address line two of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address city name of the producer / agency.
IDENTIFICATION SECTION
Enter code: The mailing address state or province code of the producer / agency.
IDENTIFICATION SECTION
Enter code: The mailing address postal code of the producer / agency.
IDENTIFICATION SECTION
Enter number: The producer's contact person's phone number. If applicable, include the area
code and extension.
IDENTIFICATION SECTION
Excluded Drivers Two
Enter text: The excluded driver's first name (given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's middle name or initial (other given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's last name (surname).
IDENTIFICATION SECTION
Enter text: The excluded driver's first name (given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's middle name or initial (other given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's last name (surname).
IDENTIFICATION SECTION
Insurance Agent (Name,
Address, & Telephone
Number) Two
Enter text: The full name of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address line one of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address line two of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address city name of the producer / agency.
IDENTIFICATION SECTION
Enter code: The mailing address state or province code of the producer / agency.
IDENTIFICATION SECTION
Enter code: The mailing address postal code of the producer / agency.
IDENTIFICATION SECTION
Enter number: The producer's contact person's phone number. If applicable, include the area
code and extension.
IDENTIFICATION SECTION
Excluded Drivers Two
Enter text: The excluded driver's first name (given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's middle name or initial (other given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's last name (surname).
IDENTIFICATION SECTION
Enter text: The excluded driver's first name (given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's middle name or initial (other given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's last name (surname).
ACORD 50 LA (2008/03)r rev. 06-04-2014
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Form Page 3
Section Name
Field Name
Description
IDENTIFICATION SECTION
Commercial Checkbox One
Check the box (if applicable): Indicates the policy is a commercial lines policy.
IDENTIFICATION SECTION
Personal Checkbox One
Check the box (if applicable): Indicates the policy is a personal lines policy.
IDENTIFICATION SECTION
Company NAIC Number One
Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION
Company Affording
Coverage (Name and
Address) 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.
IDENTIFICATION SECTION
Enter text: The first line of the insurer's mailing address.
IDENTIFICATION SECTION
Enter text: The second line of the insurer's mailing address.
IDENTIFICATION SECTION
Enter text: The city of the insurer's mailing address.
IDENTIFICATION SECTION
Enter code: The state or province code of the insurer's mailing address.
IDENTIFICATION SECTION
Enter code: The postal code of the insurer's mailing address.
IDENTIFICATION SECTION
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.
IDENTIFICATION SECTION
Effective Date One
Enter date: The effective date of the policy. The date that the terms and conditions of the policy
commence. (MM/DD/YYYY)
IDENTIFICATION SECTION
Expiration Date One
Enter date: The date on which the terms and conditions of the policy will expire. (MM/DD/YYYY)
IDENTIFICATION SECTION
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.
IDENTIFICATION SECTION
Vehicle Identification
Number One
Enter identifier: The vehicle identification number (VIN) or serial number assigned by the
manufacturer.
IDENTIFICATION SECTION
Name of Insured One
Enter text: The named insured(s) as it / they will appear on the policy declarations page.
IDENTIFICATION SECTION
Insurance Agent (Name,
Address, & Telephone
Number) One
Enter text: The full name of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address line one of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address line two of the producer / agency.
ACORD 50 LA (2008/03)r rev. 06-04-2014
Page 7 of 9
IDENTIFICATION SECTION
Enter text: The mailing address city name of the producer / agency.
IDENTIFICATION SECTION
Enter code: The mailing address state or province code of the producer / agency.
IDENTIFICATION SECTION
Enter code: The mailing address postal code of the producer / agency.
IDENTIFICATION SECTION
Enter number: The producer's contact person's phone number. If applicable, include the area
code and extension.
IDENTIFICATION SECTION
Excluded Drivers One
Enter text: The excluded driver's first name (given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's middle name or initial (other given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's last name (surname).
IDENTIFICATION SECTION
Enter text: The excluded driver's first name (given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's middle name or initial (other given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's last name (surname).
IDENTIFICATION SECTION
Commercial Checkbox Two
Check the box (if applicable): Indicates the policy is a commercial lines policy.
IDENTIFICATION SECTION
Personal Checkbox Two
Check the box (if applicable): Indicates the policy is a personal lines policy.
IDENTIFICATION SECTION
Company NAIC Number Two
Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION
Company Affording
Coverage (Name and
Address) 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.
IDENTIFICATION SECTION
Enter text: The first line of the insurer's mailing address.
IDENTIFICATION SECTION
Enter text: The second line of the insurer's mailing address.
IDENTIFICATION SECTION
Enter text: The city of the insurer's mailing address.
IDENTIFICATION SECTION
Enter code: The state or province code of the insurer's mailing address.
IDENTIFICATION SECTION
Enter code: The postal code of the insurer's mailing address.
IDENTIFICATION SECTION
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.
IDENTIFICATION SECTION
Effective Date Two
Enter date: The effective date of the policy. The date that the terms and conditions of the policy
commence. (MM/DD/YYYY)
IDENTIFICATION SECTION
Expiration Date Two
Enter date: The date on which the terms and conditions of the policy will expire. (MM/DD/YYYY)
IDENTIFICATION SECTION
Year Two
Enter year: The model year of the vehicle.
ACORD 50 LA (2008/03)r rev. 06-04-2014
Page 8 of 9
IDENTIFICATION SECTION
Make Two
Enter text: The manufacturer of the vehicle (e.g., Ford, Chevy).
IDENTIFICATION SECTION
Model Two
Enter text: The manufacturer's model name for the vehicle.
IDENTIFICATION SECTION
Vehicle Identification
Number Two
Enter identifier: The vehicle identification number (VIN) or serial number assigned by the
manufacturer.
IDENTIFICATION SECTION
Name of Insured Two
Enter text: The named insured(s) as it / they will appear on the policy declarations page.
IDENTIFICATION SECTION
Insurance Agent (Name,
Address, & Telephone
Number) Two
Enter text: The full name of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address line one of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address line two of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address city name of the producer / agency.
IDENTIFICATION SECTION
Enter code: The mailing address state or province code of the producer / agency.
IDENTIFICATION SECTION
Enter code: The mailing address postal code of the producer / agency.
IDENTIFICATION SECTION
Enter number: The producer's contact person's phone number. If applicable, include the area
code and extension.
IDENTIFICATION SECTION
Excluded Drivers Two
Enter text: The excluded driver's first name (given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's middle name or initial (other given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's last name (surname).
IDENTIFICATION SECTION
Enter text: The excluded driver's first name (given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's middle name or initial (other given name).
IDENTIFICATION SECTION
Enter text: The excluded driver's last name (surname).
ACORD 50 LA (2008/03)r rev. 06-04-2014
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