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The Acord 50 WM form is a critical document used in the insurance industry, specifically designed for workers' compensation coverage. This form serves as a standardized way for businesses to report their workers' compensation insurance needs and details to insurance providers. It captures essential information about the business, including the type of operations, the number of employees, and payroll estimates. By providing this data, the Acord 50 WM form helps insurers assess risk and determine appropriate coverage options. Furthermore, it streamlines the application process, ensuring that both insurers and businesses can communicate effectively. Understanding the nuances of this form is vital for employers seeking to navigate the complexities of workers' compensation insurance, as it directly impacts their coverage and compliance with state regulations.
Document Data
| Fact Name | Description |
|---|---|
| Purpose | The Acord 50 WM form is used to document and verify workers' compensation insurance coverage. |
| Common Use | This form is commonly utilized by businesses to provide proof of insurance to clients and regulatory bodies. |
| Standardization | The form is standardized across the industry, ensuring consistency in the information provided. |
| State-Specific Variations | Some states may require specific endorsements or additional information based on their workers' compensation laws. |
| Governing Laws | In California, for instance, the form must comply with the California Labor Code, while in New York, it adheres to the New York Workers' Compensation Law. |
| Submission Process | The completed form is typically submitted to insurance carriers or regulatory agencies as part of compliance requirements. |
How to Write Acord 50 WM
Filling out the Acord 50 WM form is a straightforward process. This form is essential for gathering necessary information, and completing it accurately helps ensure everything runs smoothly. Below are the steps to guide you through filling out the form.
- Begin by entering the name of the applicant in the designated field.
- Provide the applicant's address, including street, city, state, and zip code.
- Fill in the contact information, such as phone number and email address.
- Indicate the type of coverage being requested by checking the appropriate boxes.
- Detail the description of operations in the space provided, explaining what the business does.
- List any additional insured parties if applicable, including their names and addresses.
- Complete the signature section by signing and dating the form.
- Finally, review the entire form for accuracy before submission.
Acord 50 WM Example
For use with ACORD 360 WM, four part perforated 32 lb. paper
INSURANCE IDENTIFICATION CARD
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(STATE) |
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COMPANY NUMBER |
COMPANY |
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COMMERCIAL |
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PERSONAL |
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POLICY NUMBER |
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EFFECTIVE DATE |
EXPIRATION DATE |
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YEAR |
MAKE/MODEL |
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VEHICLE IDENTIFICATION NUMBER |
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AGENCY/COMPANY ISSUING CARD |
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INSURED
SEE IMPORTANT NOTICE ON REVERSE SIDE
INSURANCE IDENTIFICATION CARD
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(STATE) |
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COMPANY NUMBER |
COMPANY |
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COMMERCIAL |
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PERSONAL |
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POLICY NUMBER |
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EFFECTIVE DATE |
EXPIRATION DATE |
|||
YEAR |
MAKE/MODEL |
|
VEHICLE IDENTIFICATION NUMBER |
||||
AGENCY/COMPANY ISSUING CARD |
|
|
|
|
|
||
INSURED
SEE IMPORTANT NOTICE ON REVERSE SIDE
INSURANCE IDENTIFICATION CARD
|
(STATE) |
|
|
|
|
|
|
COMPANY NUMBER |
COMPANY |
|
|
COMMERCIAL |
|
PERSONAL |
|
POLICY NUMBER |
|
|
EFFECTIVE DATE |
EXPIRATION DATE |
|||
YEAR |
MAKE/MODEL |
|
VEHICLE IDENTIFICATION NUMBER |
||||
AGENCY/COMPANY ISSUING CARD |
|
|
|
|
|
||
INSURED
SEE IMPORTANT NOTICE ON REVERSE SIDE
INSURANCE IDENTIFICATION CARD
|
(STATE) |
|
|
|
|
|
|
COMPANY NUMBER |
COMPANY |
|
|
COMMERCIAL |
|
PERSONAL |
|
POLICY NUMBER |
|
|
EFFECTIVE DATE |
EXPIRATION DATE |
|||
YEAR |
MAKE/MODEL |
|
VEHICLE IDENTIFICATION NUMBER |
||||
AGENCY/COMPANY ISSUING CARD |
|
|
|
|
|
||
INSURED
SEE IMPORTANT NOTICE ON REVERSE SIDE
THIS CARD MUST BE KEPT IN THE INSURED
VEHICLE AND PRESENTED UPON DEMAND
IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as soon as possible. Obtain the following information:
1.Name and address of each driver, passenger and witness.
2.Name of Insurance Company and policy number for each vehicle involved.
THE FRONT OF THIS DOCUMENT CONTAINS AN ARTIFICIAL WATERMARK - HOLD AT AN ANGLE TO VIEW
ACORD 50 WM (2007/03) |
© ACORD CORPORATION |
THIS CARD MUST BE KEPT IN THE INSURED
VEHICLE AND PRESENTED UPON DEMAND
IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as soon as possible. Obtain the following information:
1.Name and address of each driver, passenger and witness.
2.Name of Insurance Company and policy number for each vehicle involved.
THE FRONT OF THIS DOCUMENT CONTAINS AN ARTIFICIAL WATERMARK - HOLD AT AN ANGLE TO VIEW
ACORD 50 WM (2007/03) |
© ACORD CORPORATION |
THIS CARD MUST BE KEPT IN THE INSURED
VEHICLE AND PRESENTED UPON DEMAND
IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as soon as possible. Obtain the following information:
1.Name and address of each driver, passenger and witness.
2.Name of Insurance Company and policy number for each vehicle involved.
THE FRONT OF THIS DOCUMENT CONTAINS AN ARTIFICIAL WATERMARK - HOLD AT AN ANGLE TO VIEW
ACORD 50 WM (2007/03) |
© ACORD CORPORATION |
THIS CARD MUST BE KEPT IN THE INSURED
VEHICLE AND PRESENTED UPON DEMAND
IN CASE OF ACCIDENT: Report all accidents to your Agent/Company as soon as possible. Obtain the following information:
1.Name and address of each driver, passenger and witness.
2.Name of Insurance Company and policy number for each vehicle involved.
THE FRONT OF THIS DOCUMENT CONTAINS AN ARTIFICIAL WATERMARK - HOLD AT AN ANGLE TO VIEW
ACORD 50 WM (2007/03) |
© ACORD CORPORATION |
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