ACORD 90 NY (2003/11) – New York 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.
- A REGISTERED TO DRIVER # column is added to the VEHICLEDESCRIPTION/USE section to collect information as to which driver owns each vehicle. This information is now required in NY state.
- ADDITIONAL INTEREST Section has check boxes for Owner, Lienholder and Registrant as well as for Addl Int and Loss Pay.
- Supplemental Spousal Liability Coverage is Offered.
- Personal Injury Protection coverages are revised to reflect New York’s unique coverages and options. Refer to your state Manual.
- A note is added to GENERAL INFORMATION question 1, relating to vehicle ownership. The note provides that, if the owner of any vehicle is different than the applicant for insurance, the name(s) that appear on the vehicle registration must be provided. This information is required because New York DMV rules provide that the Named Insured in an auto policy must be the same as the owner of the vehicle.
- An additional GENERAL INFORMATION question is included regarding any applicant covered by a wage continuation plan. If coverage applies, the name of the plan and the person(s) covered must be shown in the application. New York State law requires a reduction in work loss payment under Personal Injury Protection coverage and a PIP premium reduction, if an insured is covered by a qualified wage continuance plan.
- Uninsured and Underinsured Motorists coverages are replaced by “Statutory UM/UIM” and “Supplemental UM (SUM)”. Refer to your State Manual.
- The figure “39 months” is inserted in the Accidents/Convictions section. This is the legal limit in New York State with respect to the reporting of this information.
- Provision is made for the selection of “Full Glass (FG)” coverage under Comprehensive and Collision.
- Fraud statement text is specific to this state.
- Statement added to the back of the form referencing the availability of Statutory Uninsured Motorists and Supplementary Uninsured Motorists coverages and options.