ACORD 90 MN (2004/01) – Minnesota 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.
- Personal Injury Protection coverage reflects Minnesota’s unique coverages.
- Uninsured and Underinsured Bodily Injury coverage is combined; there is no Property Damage coverage.
- Comprehensive coverage can include “Full Glass” coverage; refer to your rating manual.
- Information relating to accidents is limited to the last five (5) years, and information relating to suspension or revocation of drivers licenses is limited to ten (l0) years.
- A statement is added requiring the applicant to acknowledge receipt of a copy of the Minnesota Guaranty Association Notice (ACORD 65 MN).
- A statement is added requiring the applicant to acknowledge the offering of Uninsured/Underinsured Motorists coverage up to the limits of BI Liability.
- A statement is added referencing the company’s right to cancel coverage during the forty-nine days following the issuance of coverage, for any reason not prohibited by law.
- A statement is added referring to the Work Loss Exclusion in the Personal Injury Protection coverage.
- The fraud statement on the back of the form is revised to reflect a new Minnesota law.
- A check box is provided indicating that the applicant has received a copy of the long version of the Notice of Information Practices and that the abbreviated version of the Notice of Information Practices printed on the form does not apply.
- Notice of Information Practices (Privacy) contains text specific to Minnesota requirements.
- A check box is provided indicating that credit scoring will be used for the purpose of underwriting the policy and/or determining the premium that the applicant will be charged.