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Workers Compensation Funds Forms



Form #GID-254-RS This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 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.
PID:241-SID:376-FN:GID-254-RS.pdf

Form #GID-263-RS This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2019
Title: Application For Membership In Group Self-Insurance Fund
Application For Membership In Group Self-Insurance Fund. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal. Effective 1-1-2012, submit with the application the Citizenship Affidavit Form GID-276-EN which is required of persons making application for all licenses 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.
PID:771-SID:1578-FN:GID-263-RS.pdf

Form #GID-276-EN This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2015
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.
PID:788-SID:2817-FN:GID-276-EN.pdf

Form #GID-382-NT This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2013
Title: Workers Compensation Self-Insurance Fund Annual Renewal Check Sheet
Use form to verify that all necessary requirements and documentation have been provided.
PID:1083-SID:2824-FN:GID-382-NT.pdf

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