Office of Insurance and Safety Fire CommissionerRalph T. Hudgens
Commissioner
Home Agents Agencies Insurers Fire Marshal Industrial Loan Consumer Services Premium Tax Legal Fraud

Agencies Forms

ATTENTION: TO ALL NEW APPLICANTS - EFFECTIVE 1/1/2012. 
In accordance with state law, beginning January 1, 2012, the Office of Insurance and Safety Fire Commissioner will be changing its procedures regarding the verification of lawful presence of persons applying for all licenses, permits, registrations and certificates. Please click HERE for more information.

ATTENTION:
 We have NEW IMPORTANT payment procedures. Please view them HERE.

Form #: GID-101A-AL This is in the Adobe Portable Document format (pdf)\nDivision: Agents LicensingPublished: 2013
Title: Business Entity License Renewal Application
Business Entity License Renewal Application. A Citizen Affidavit form is required with this application if the person who has authority to apply for licensure on behalf of this licensed business entity either: is a non-citizen /alien of the United States, or has not previously provided a Citizen Affidavit for this business entity. If Yes, to either a) or b), then include the GID-276-EN Citizen Affidavit Form with this renewal. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-130-AL This is in the Adobe Portable Document format (pdf)\nDivision: Agents LicensingPublished: 2012
Title: Agency License Application
Effective 1-1-2012, the Citizenship Affidavit Form GID-276-EN must be submitted with this application for processing. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-130A-AL JAN2013 This is in the Adobe Portable Document format (pdf)\nDivision: Agents LicensingPublished: 2013
Title: Request For Name Approval Form
Instructions and form for requesting name approval.

Form #: GID-276-EN This is in the Adobe Portable Document format (pdf)\nDivision: Agents LicensingPublished: 2013
Title: Citizenship Affidavit
Effective 1-1-2012, this form is required of persons making application for all licenses, permits, registrations and certifications in order to comply with the Georgia Illegal Immigration Reform And Enforcement Act. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-365-AL This is in the Adobe Portable Document format (pdf)\nDivision: Agents LicensingPublished: 2012
Title: Retail Vendors Of Portable Electronics Application
This form is used to apply for a license. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal. Effective 1-1-2012, the Citizenship Affidavit Form GID-276-EN must be submitted with this application.

Form #: GID-366-EN This is in the Adobe Portable Document format (pdf)\nDivision: Agents LicensingPublished: 2012
Title: Self-Storage Provider License Application
This form is used to apply for a license. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal. Effective 1-1-2012, the Citizenship Affidavit Form GID-276-EN must be submitted with the application.

Form #: UANRBEILR JAN2013 This is in the Adobe Portable Document format (pdf)\nDivision: Agents LicensingPublished: 2013
Title: Uniform Application For Business Entity Insurance License Registration
Includes instructions for non-residents, the application and the Citizenship Affidavit. Effective 1-1-2012, the Citizenship Affidavit Form GID-276-EN is required of persons making application for all licenses, permits, registrations and certifications in order to comply with the Georgia Illegal Immigration Reform And Enforcement Act. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

4/19/2014 12:50:54 AM
EmploymentE-VerifySitemapTechnical ContactContact UsPrivacy PolicyLaws & Regs
172.16.0.31