Insurers Forms - Workers Compensation Group Self insurance

Office of Insurance and Safety Fire Commissioner

Ralph T. Hudgens

Commissioner

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Workers Compensation Group Self Insurance 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 #: Citizenship Affidavit GID-276-EN $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 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-254-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Application for Renewal of Certificate of Authority for Group Self-Insurance Fund - same as GSF-2
This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us. 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-254-RS (same as GSF-2) Instructions $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2005
Title: Workers Comp Group SeIf-Insurance Fund Annual Statement Filing Instructions
This memo provides instructions for the Annual Statement Filing.

5/25/2013 4:09:38 AM

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