ACORD 58 PDF – Notice of Cancellation or Termination of Policy

ACORD 58 (2007/11)

Notice of Cancellation or Termination of Policy

Form Number:

ACORD 58 (2007/11)

Category:

Policy Change

Last Updated:

November 2007

Page Count:

01 Page

File Format:

PDF, Fillable PDF

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ACORD 58

When an insurance policy ends, is cancelled, or is terminated, it’s important to have proper documentation to confirm the cancellation and keep all parties informed, especially the Department of Motor Vehicles, the policyholder, and the insurance carrier. The Acord 58, officially known as the notice of cancellation or termination of policy, is used by insurance carriers to notify the DMV or other regulatory bodies that a specific insurance policy has been cancelled or is no longer active. Additionally, this form helps ensure legal compliance and maintains accurate, up-to-date records, including vehicle registration and insurance information. To complete your process, you can fill out and download the form online right here, saving time and ensuring proper documentation.

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Benefits of The Acord 58 PDF Form

Maintained Records

By using this form, the DMV receives accurate and up-to-date information about the insurance status of vehicles. It helps prevent issues, such as registration suspension, invalid license plates, or fines caused by outdated insurance records.

Simplifies Multi-Vehicle Reporting

The Acord 58 form allows multiple vehicles to be listed under a single policy, which is helpful for commercial fleets with several insured vehicles, containing all required information, such as make, year, model, and VIN, to be reported together.

Support Legal And Audit Documentation

Having an accurate, up-to-date, and completed form protects the policyholder and insurer in case of future audits or disputes. It provides documented evidence of when the policy ended, which can be helpful for legal or financial recordkeeping.

Key Sections of Acord 58 Fillable Form

Header Section

The first section of the document contains basic information, such as the state name and the current date of application.

Policy Information

This section describes the carrier name, NAIC number, effective and expiration dates, termination date, policy number, and agent name.

Policyholder Details

It specifies the name and address of the policyholder.

Reason For Cancellation

This section contains checkboxes for reasons, such as policyholder request, non-payment of premium, underwriting reasons, and others.

Vehicle Information

The vehicle section describes the vehicle’s make, year, model, and VIN.

Department of Motor Vehicles Section

It specifies the name and address of the DMV office receiving the cancellation notice.

How To Complete The Acord 58 Fillable Form?

  1. State Information: Specify the state name.
  2. Policy Information: Fill in the carrier, NAIC code, effective, expiration, and termination dates, policy number, and the name of the agent.
  3. Policyholder Information: Write the policyholder’s name and address.
  4. Reason of Cancellation: Indicate the appropriate reason for cancellation or termination.
  5. Vehicle Details: List each vehicle, including year, make, model, and vehicle identification number (VIN).
  6. Department / Division of Motor Vehicle Information: Write the DMV name and complete address.
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Frequently Asked Questions

This form is used to notify the Department of Motor Vehicles (DMV) or regulatory authority that an insurance policy has been cancelled or terminated. It ensures that all vehicle insurance records remain accurate and that the DMV is aware of any change in coverage status.

This form complies with state laws that require insurers to report cancelled or terminated policies. Additionally, it prevents issues, such as vehicle registration suspension or fines for uninsured vehicles.

The policyholder can’t submit the form directly. Generally, it is the agent’s or the insurer’s responsibility to notify the DMV.

Of course, you can use this form for any state. But it is recommended to verify your state’s regulations and submission rules.

  • Non-payment of premium
  • Underwriting reasons
  • Policyholder request
  • Other (with a description)

Of course, we let users fill out, sign, download, and submit the form online, making the process quicker and more convenient.

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