ACORD 90 Form – Personal Auto Application PDF Download
ACORD 90 (2014/12)
Personal Auto Application
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Form Number: |
ACORD 90 (2014/12) |
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Category: |
Auto Insurance |
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Last Updated: |
December 2014 |
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Page Count: |
04 pages |
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File Format: |
PDF, Fillable PDF |
ACORD 90
The Personal Auto Application is a standardized document widely used by insurance companies to gather all required information about the applicant, vehicles, and drivers before applying for personal auto coverage. Additionally, it helps insurers in premium calculations, evaluates risks, and determines eligibility. By completing this form accurately, the applicants can secure the right coverage. For a reliable application process, you can download or fill out the Acord 90 form directly from AcordForm.net.
Form Preview
Benefits of the Acord 90 Fillable PDF
Clear & Detailed Vehicle Information
The form records each vehicle’s number, year, make, model, mileage, purpose, class, etc., helping insurers accurately assess the value and risks of every insured vehicle.
Efficient Policy Binding
The acord 90 pdf form has a dedicated signature and binding section, which makes it possible to set effective and expiration dates, ensuring coverage starts quickly once the application is accepted.
Driver History Transparency
The Acord 90 form lists all household residents and regular drivers, including their age, DOB, license details, training, and occupation. It prevents hidden risks.
Key Sections of Acord 90 Form
Applicant & Agency Information
This section gathers applicant information and producer/agency details, including their name, contact number, address, etc.
Residence & Garaging Information
It describes whether the applicant owns or rents their home and where the vehicles are garaged.
Coverage & Premiums
The section includes liability, medical payments, PIP, UM/UIM/ collision, and coverage options.
Vehicles Information
Contains vehicle data, including make, year, model, usage type, VIN, mileage, and anti-theft devices.
Driver Information
This section lists all household residents and drivers with their date of birth, license details, occupation, and driving experience.
Accidents and Convictions
It contains accidents and traffic violation history for up to 39 months.
Employment Information
It specifies the employment details of the applicant and the co-applicant.
General Information
This section contains multiple questions about modified vehicles, existing damage, etc.
Additional Interest
It lists any lienholders, owners, and registrants.
Signature and Binder Section
It contains the applicant’s certification, a fraud statement, the producer’s signature, and the effective dates.
How To Complete The Acord Personal Auto Application?
- Agency Information: Provide the agency/producer details, including agency name, contact number, phone & fax number, email address, agency code & subcode, customer ID, etc.
- Applicant Information: Fill in the applicant’s name, mailing address, telephone number, tax ID,etc.
- Insurance Information: Provide the carrier name, plan, NAIC code, policy number, acc number, effective & expiration date, and payment plan.
- Residence & Garaging Address: Indicate whether the current residence is rented or owned. Also, provide the garaging address if different from the mailing address.
- Vehicle Information: List each vehicle, including vehicle number, class, VIN, model, make, year, type, annual mileage, usage, purpose, anti-theft devices, and garaging details.
- Coverage & Premiums: Select liability limits, property damage, personal injury protection, insured/uninsured motorists medical payments, collision, towing, and rental reimbursement options. Also, write applicable deductibles and limits for each vehicle.
- Resident & Driver Information: List all household members and drivers with their name, date of birth, marital status, occupation, license number, driver training, etc.
- Accidents & Convictions: Describe the complete accident and violation history, including date, description, place, damage amount, etc.
- Additional Interest: Identify additional interest, including name, address, and loan number.
- Employment Information: Specify the applicant’s employer & co-applicant’s employer, including their work address, work phone number, and number of years of employment at current and previous work.
- Prior Coverage: Describe prior coverage, including prior carrier, number of years with the company, prior policy number, and prior producer.
- General Information: Answer all questions regarding vehicles, existing damage, other auto insurance, cancellations, medical impairments, repossessions, etc., and provide explanations of each question with a “Yes” response.
- Remark/Attachments: Attach required documents or attachments, such as state supplement, anti-theft device certificate, medical statement, etc.
- Binder/Signature: The applicant and the producer must sign and date the form.
Frequently Asked Questions
Related Forms
Commercial Insurance
ACORD 75
While waiting for a policy after submitting ACORD 90, a binder is often used for temporary coverage.
Auto Insurance
ACORD 137
The ACORD 137 Auto form uses specific vehicle symbols to clearly indicate which automobiles are insured under each section of the policy.
Commercial Lines
ACORD 175
It is commonly required to record lienholders, lessors, or other interested parties connected to the policy.