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Continuing Care Retirement Community Forms

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Form #: CCRC Renewal Instructions Letter This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2013
Title: Annual Statement Filing Instructions
As a licensed Continuing Care Provider (CCRC), our law and regulations require you to file an annual statement and notice of major change in the organization by May 1. Specifically the law found at O.C.G.A. ยง 33-45-5.

Form #: GID-059-NT This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2012
Title: Continuing Care Provider and Facility Biographical Affidavit
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-060-NT This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2013
Title: Annual Statement for Continuing Care Provider and Facility
This form is completed annually for the Provider and the Facility. Included are three parts to this form comprising general interrogatories and the statement of financial condition. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-061-NT This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2012
Title: Application For Certificate Of Authority As A Continuing Care Provider
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal. 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, 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-061-NT Instructions Letter This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2012
Title: Instructions For Application For Certificate Of Authority As A Continuing Care Provider
This document explains the requirements for making Application For Certificate Of Authority As A Continuing Care Provider.

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.

Form #: GID-372-NT This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2013
Title: Continuing Care Retirement Community Disclosure Statement Checklist
Continuing Care Retirement Community Disclosure Statement Checklist. This form is to be filed as an accompanying document to the Disclosure Statement.

Form #: GID-384-NT This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2013
Title: Continuing Care Retirement Community Annual Renewal Check Sheet
Continuing Care Retirement Community Annual Renewal Check Sheet

4/17/2014 11:09:16 PM
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