Office of Insurance and Safety Fire CommissionerRalph T. Hudgens
Commissioner
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Insurers Forms - Auto Self Insured 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 #: Automobile Self-Insured Renewal Letter This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2009
Title: Automobile Self-Insured Renewal Letter
Automobile Self-Insured Renewal Letter

Form #: GID-043-RS This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2010
Title: Automobile Self-Insurer Bond Form
Automobile Self-Insurer Bond Form and Instructions

Form #: GID-255-RS This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2012
Title: Automobile Application For Self-Insurance
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-276-EN This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 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.

4/23/2014 5:15:00 AM
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