ACORD 90 Form | Personal Auto Application (PDF)

ACORD 90 is the Personal Auto Application, the form an agent fills in to apply for car insurance on a household’s own vehicles. It isn’t one fixed form, though. Because auto insurance rules differ by state, ACORD publishes it separately for nearly every one, so a California version and a New York version genuinely ask different questions. This page walks through New York’s, and flags where a different state’s personal auto ACORD form would diverge from it.

Ten sections across four pages, in the order they appear.

1. 1

   Producer & Applicant

   The agency issuing the application, and the applicant’s name, mailing address, and phone number.

2. 2

   Residence & Garaging

   Where the applicant currently lives, how long they’ve been there, and where each vehicle is actually kept, if that’s a different address.

3. 3

   Vehicle Description / Use

   Year, make, model, and VIN for each vehicle, along with mileage, how it’s used, and who drives it.

4. 4

   Coverages / Premiums

   The limits and deductibles requested for each vehicle: liability, collision, comprehensive, and the optional coverages New York allows. New York’s legal minimum is 25/50/10, meaning $25,000 of bodily injury coverage per person, $50,000 per accident, and $10,000 of property damage, plus $50,000 of personal injury protection. Most drivers carry more than the minimum, but this is the floor the state sets.

5. 5

   Prior Insurance & Accidents

   The previous carrier and policy, a list of accidents or violations for each driver, and whether this is “assigned risk” business, meaning the applicant couldn’t get coverage through a regular insurer and was placed with one through the state’s high-risk pool instead.

6. 6

   Additional Interest

   Anyone with a financial stake in a vehicle: an owner, a lienholder, a loss payee, or a lender under a loss payable clause.

7. 7

   General Information

   Eighteen yes/no questions: license suspensions, prior cancellations, modified vehicles, existing damage, military service, and whether any driver has a medical condition that could affect their ability to drive. Every yes needs a short explanation.

8. 8

   Resident & Driver Information

   Every household resident and regular driver, licensed or not, with license number, date of birth, and marital status.

9. 9

   Employment Information

   The applicant’s and co-applicant’s employer, how long they’ve worked there, and their occupation.

10. 10

    Attachments, Remarks & Signature

    A checklist of extra documents that sometimes come with it, a vehicle photo, a bill of sale, a motor vehicle report, a good student or driver training certificate, or a state supplement. If a driver’s history doesn’t fit the space given, ACORD 99 provides more room, and New York applicants are also given ACORD 38 NY, a required privacy notice. Last comes the binder and signature block, and it’s the part worth reading closely: if an agent fills in the binder section with an effective date and time, coverage starts right then. If it’s left blank, the form says plainly that coverage is not bound, filling out the application isn’t the same as having insurance.

Most people don’t expect their credit report to matter for car insurance, but the form discloses that it can. Insurers are allowed to review a credit report, or use a credit-based insurance score built from it, to help set the premium. The factors it names specifically are payment history, the number of revolving accounts, the number of new accounts, any collection accounts, and past bankruptcies or foreclosures. The notice also says the applicant has the right to see what personal information was collected and to correct anything that’s wrong.

New York treats a false statement here as a specific crime, not just a paperwork problem. The fraud warning printed near the signature states that anyone who knowingly files an application with materially false information, or leaves something out to mislead the insurer, commits a fraudulent insurance act. The penalty for each violation can reach $5,000 plus the value of whatever claim was involved. That’s worth keeping in mind through the eighteen background questions, since an inaccurate yes or no there carries more weight than it might seem to.

Page four carries a right most people never notice. If rental reimbursement coverage was purchased and the vehicle is out of service because of a covered loss, New York law says the policyholder gets to pick, in the form’s own words, “any rental vehicle company, rental vehicle location or a particular concern of your choice.” An insurer can suggest a preferred rental company, but it can’t require one. Worth remembering the next time an adjuster hands over a list and it feels like there’s only one option.

This part is easy to miss because it’s in the fine print near the signature, not in the coverage section. The form states that the applicant confirms having had statutory uninsured motorists and Supplementary Uninsured/Underinsured Motorists (SUM) coverage explained, and that the coverage and limits chosen here will apply to “all future renewals, continuations and changes” unless the insurer is notified otherwise in writing. In other words, this isn’t a one-time decision. Whatever SUM limit gets picked on this application keeps carrying forward year after year until someone actively asks to change it.