ACORD 90MI Instructions


ACORD 90 MI (2003/04)Michigan Personal Auto Application


Following are the differences from ACORD 90, the generic Personal Auto Application. For instructions on completing the balance of this form, refer to ACORD 90, the generic Personal Auto Application Instructions, on this website.

  • Additional Property Damage Liability coverage in the amount of $500.00 is a basic liability coverage.
  • Personal Injury Protection coverages have been revised to allow for unique Michigan coverages and options. Refer to your state manual.
  • No property damage coverage is available under Uninsured or Underinsured Motorists.
  • Several collision options are shown. Refer to your state manual.
  • The “Good Student” box in the Resident and Driver Information section is deleted, as required by the Michigan Insurance Bureau.
  • Information relating to accidents is limited to the last 5 years, and information relating to coverage cancellation or declination is limited to the last 3 years.
  • Reference to Young Driver Questionnaire, Good Student Certificate and Medical Statement are deleted from the Attachments section.
  • The Fair Credit Reporting Account Statement, Fraud Statement and Applicants Statement on the back of the form have been revised to comply with Michigan law and regulations.
  • The question “How long have you known the applicant?” is deleted, to comply with regulations.
  • Provision is made to allow individuals covered under the policy who are 60 years of age or older, and who have no expectation of actual income loss in the event of an accident, to reject coverage for work loss under Personal Injury Protectioncoverage. Each individual eligible must sign the application.
  • A statement is added referencing the Michigan Collision Insurance Options Notice (ACORD 62 MI) which must be given to every applicant for auto insurance in Michigan.
  • A statement is added that provides theaddress and phone number of the Michigan Insurance Bureau.