Free Michigan No Fault Insurance Template in PDF
Understanding the Michigan No Fault Insurance form is essential for every vehicle owner in the state. This document serves as proof that you have the necessary insurance coverage mandated by Michigan law. It contains vital information such as your policy number, effective dates, and details about your vehicle, including its make, model, and identification number. Issued by an authorized Michigan insurer, this form confirms compliance with the No-Fault Insurance Act, which ensures that drivers have appropriate coverage for no-fault benefits. It’s important to keep this certificate in your vehicle at all times; failing to present it to law enforcement when requested can lead to civil infractions. Additionally, the form plays a crucial role when applying for license plates, as it must be submitted to the Secretary of State. A warning is included on the form regarding the consequences of driving without valid insurance, which can result in significant fines or even imprisonment. Therefore, being familiar with this form and its requirements can help you avoid legal troubles and ensure that you are adequately protected while on the road.
Form Example
VEHICLE COPY - FRONT SIDE
STATE OF MICHIGAN CERTIFICATE OF
COMPANY |
|
|
|
COMMERCIAL |
|
PERSONAL |
POLICY NUMBER |
|
EFFECTIVE DATE |
EXPIRATION DATE |
|||
YEAR |
MAKE/MODEL |
VEHICLE IDENTIFICATION NUMBER |
||||
AGENCY/COMPANY ISSUING CARD
INSURED
An authorized Michigan insurer, certifies that it has issued a policy complying with Act 294, P.A. 1972, as amended for the described motor vehicle.
WARNING: KEEP THIS CERTIFICATE IN YOUR VEHICLE AT ALL TIMES. If you fail to produce it upon a police officer's request, you will be respon- sible for a civil infraction.
STATE OF MICHIGAN CERTIFICATE OF
COMPANY |
|
|
|
COMMERCIAL |
|
PERSONAL |
POLICY NUMBER |
|
EFFECTIVE DATE |
EXPIRATION DATE |
|||
YEAR |
MAKE/MODEL |
VEHICLE IDENTIFICATION NUMBER |
||||
AGENCY/COMPANY ISSUING CARD
INSURED
An authorized Michigan insurer, certifies that it has issued a policy complying with Act 294, P.A. 1972, as amended for the described motor vehicle.
WARNING: KEEP THIS CERTIFICATE IN YOUR VEHICLE AT ALL TIMES. If you fail to produce it upon a police officer's request, you will be respon- sible for a civil infraction.
SECRETARY OF STATE'S COPY - FRONT SIDE
STATE OF MICHIGAN CERTIFICATE OF
COMPANY |
|
|
|
COMMERCIAL |
|
PERSONAL |
POLICY NUMBER |
|
EFFECTIVE DATE |
EXPIRATION DATE |
|||
YEAR |
MAKE/MODEL |
VEHICLE IDENTIFICATION NUMBER |
||||
AGENCY/COMPANY ISSUING CARD
INSURED
An authorized Michigan insurer, certifies that it has issued a policy complying with Act 294, P.A. 1972, as amended for the described motor vehicle.
SECRETARY OF STATE'S COPY
STATE OF MICHIGAN CERTIFICATE OF
COMPANY |
|
|
|
COMMERCIAL |
|
PERSONAL |
POLICY NUMBER |
|
EFFECTIVE DATE |
EXPIRATION DATE |
|||
YEAR |
MAKE/MODEL |
VEHICLE IDENTIFICATION NUMBER |
||||
AGENCY/COMPANY ISSUING CARD
INSURED
An authorized Michigan insurer, certifies that it has issued a policy complying with Act 294, P.A. 1972, as amended for the described motor vehicle.
SECRETARY OF STATE'S COPY
SECRETARY OF STATE'S COPY - REVERSE SIDE |
VEHICLE COPY - REVERSE SIDE |
Michigan Law (MCLA 500.3101) requires that the owner or registrant of a motor vehicle regis- tered in this state must have insurance or other approved security for the payment of
An owner or registrant convicted of such a misdemeanor shall be fined not less than $200.00 nor more than $500.00, or imprisoned for not more than 1 year, or both.
THIS FORM MUST BE PRESENTED AS EVIDENCE OF INSURANCE WITH YOUR APPLICA- TION FOR LICENSE PLATES, EITHER BY MAIL OR AT ANY SECRETARY OF STATE LICENSE PLATE BRANCH OFFICE. A PERSON WHO ISSUES OR WHO SUPPLIES FALSE INFORMA- TION TO THE SECRETARY OF STATE OR USES AN INVALID CERTIFICATE OF INSURANCE IS GUILTY OF A MISDEMEANOR PUNISHABLE BY IMPRISONMENT FOR NOT MORE THAN 1 YEAR, OR A FINE OF NOT MORE THAN $1,000.00, OR BOTH.
If this vehicle is driven by the person(s) named below, residual liability insurance does not apply and the vehicle will be considered uninsured:
WARNING - when a named excluded person operates a vehicle, all liability coverage is void - no one is insured. Owners of the vehicle and others legally responsible for the acts of the named excluded person remain fully responsible.
ACORD 50 MI (2007/12) |
© 1993, 2007 ACORD CORPORATION. All rights reserved. |
Michigan Law (MCLA 500.3101) requires that the owner or registrant of a motor vehicle regis- tered in this state must have insurance or other approved security for the payment of
An owner or registrant convicted of such a misdemeanor shall be fined not less than $200.00 nor more than $500.00, or imprisoned for not more than 1 year, or both.
THIS FORM MUST BE PRESENTED AS EVIDENCE OF INSURANCE WITH YOUR APPLICA- TION FOR LICENSE PLATES, EITHER BY MAIL OR AT ANY SECRETARY OF STATE LICENSE PLATE BRANCH OFFICE. A PERSON WHO ISSUES OR WHO SUPPLIES FALSE INFORMA- TION TO THE SECRETARY OF STATE OR USES AN INVALID CERTIFICATE OF INSURANCE IS GUILTY OF A MISDEMEANOR PUNISHABLE BY IMPRISONMENT FOR NOT MORE THAN 1 YEAR, OR A FINE OF NOT MORE THAN $1,000.00, OR BOTH.
If this vehicle is driven by the person(s) named below, residual liability insurance does not apply and the vehicle will be considered uninsured:
WARNING - when a named excluded person operates a vehicle, all liability coverage is void - no one is insured. Owners of the vehicle and others legally responsible for the acts of the named excluded person remain fully responsible.
ACORD 50 MI (2007/12) |
© 1993, 2007 ACORD CORPORATION. All rights reserved. |
Michigan Law (MCLA 500.3101) requires that the owner or registrant of a motor vehicle regis- tered in this state must have insurance or other approved security for the payment of
An owner or registrant convicted of such a misdemeanor shall be fined not less than $200.00 nor more than $500.00, or imprisoned for not more than 1 year, or both.
A PERSON WHO SUPPLIES FALSE INFORMATION TO THE SECRETARY OF STATE OR WHO ISSUES OR USES AN INVALID CERTIFICATE OF INSURANCE IS GUILTY OF A MISDEMEAN- OR PUNISHABLE BY IMPRISONMENT FOR NOT MORE THAN 1 YEAR, OR A FINE OF NOT MORE THAN $1,000.00, OR BOTH.
If this vehicle is driven by the person(s) named below, residual liability insurance does not apply and the vehicle will be considered uninsured:
WARNING - when a named excluded person operates a vehicle, all liability coverage is void - no one is insured. Owners of the vehicle and others legally responsible for the acts of the named excluded person remain fully responsible.
ACORD 50 MI (2007/12) |
© 1993, 2007 ACORD CORPORATION. All rights reserved. |
Michigan Law (MCLA 500.3101) requires that the owner or registrant of a motor vehicle regis- tered in this state must have insurance or other approved security for the payment of
An owner or registrant convicted of such a misdemeanor shall be fined not less than $200.00 nor more than $500.00, or imprisoned for not more than 1 year, or both.
A PERSON WHO SUPPLIES FALSE INFORMATION TO THE SECRETARY OF STATE OR WHO ISSUES OR USES AN INVALID CERTIFICATE OF INSURANCE IS GUILTY OF A MISDEMEAN- OR PUNISHABLE BY IMPRISONMENT FOR NOT MORE THAN 1 YEAR, OR A FINE OF NOT MORE THAN $1,000.00, OR BOTH.
If this vehicle is driven by the person(s) named below, residual liability insurance does not apply and the vehicle will be considered uninsured:
WARNING - when a named excluded person operates a vehicle, all liability coverage is void - no one is insured. Owners of the vehicle and others legally responsible for the acts of the named excluded person remain fully responsible.
ACORD 50 MI (2007/12) |
© 1993, 2007 ACORD CORPORATION. All rights reserved. |
Document Specs
| Fact Name | Description |
|---|---|
| Governing Law | The Michigan No Fault Insurance form is governed by Act 294, P.A. 1972, as amended. |
| Insurance Requirement | Michigan law mandates that all vehicle owners must have insurance or approved security for no-fault benefits at all times. |
| Consequences of Non-Compliance | Driving without proper insurance is a misdemeanor, punishable by fines ranging from $200 to $500 or up to one year in jail. |
| Presentation Requirement | This form must be presented as proof of insurance when applying for license plates at any Secretary of State office. |
| False Information Penalty | Providing false information or using an invalid certificate can lead to a misdemeanor charge, with penalties including fines up to $1,000 or imprisonment. |
| Residency Liability | If a named excluded person operates the vehicle, all liability coverage becomes void, and the vehicle is considered uninsured. |
| Certificate Storage | It is essential to keep the certificate in the vehicle at all times to avoid civil infractions. |
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