Insurers: GID Form Inventory

Office of Insurance and Safety Fire Commissioner

Ralph T. Hudgens

Commissioner

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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 #: Captive Insurance Company $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Filing Requirements Memo
Provides the requirements for filing as a Captive Insurance Company,

Form #: CHECKLIST - Fraternal Societies $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2013
Title: Fraternal Societies Checklist
Provides a guide to the requirements for the 2013 annual filing.

Form #: CHECKLIST - Health Entities $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2013
Title: Health Entities Checklist
Provides a guide to the requirements for the 2013 annual filing.

Form #: CHECKLIST - Life, Accident and Health Insurers $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2013
Title: Life, Accident and Health Insurers Checklist
Provides a guide to the requirements for the 2013 annual filing.

Form #: CHECKLIST - Property and Casualty Insurers $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2013
Title: Property and Casualty Insurers Checklist
Provides a guide to the requirements for the 2013 filing.

Form #: CHECKLIST - Title Companies $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2013
Title: Title Companies Checklist
Provides a guide to the requirements for the 2013 annual filing.

Form #: Citizenship Affidavit GID-276-EN $This is in the Adobe Portable Document format (pdf)\n$	Division: Enforcement	Published: 2013
Title: 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.

Form #: GID-001-IL with GID-004-IL $This is in the Adobe Portable Document format (pdf)\n$	Division: Industrial Loan	Published: 2012
Title: Corporation Application for License to Operate Business under Georgia Industrial Loan Act
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.

Form #: GID-002-IL with GID-004-IL $This is in the Adobe Portable Document format (pdf)\n$	Division: Industrial Loan	Published: 2012
Title: Partnership Application for License to Operate Business under Georgia Industrial Loan Act
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.

Form #: GID-003-IL with GID-004-IL $This is in the Adobe Portable Document format (pdf)\n$	Division: Industrial Loan	Published: 2012
Title: Proprietorship Application for License to Operate Business under Georgia Industrial Loan Act
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. Replaces GID-FO-IL-3.

Form #: GID-003-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2010
Title: Appointment of Attorney-in-fact by Insurer
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-003-RS Memo $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2009
Title: Appointment of Attorney-in-fact by Insurer (Memo)
Memo regarding Appointment of Attorney-in-fact by Insurer

Form #: GID-004-IL $This is in the Adobe Portable Document format (pdf)\n$	Division: Industrial Loan	Published: 2011
Title: Convenience and Advantage Documentation
Convenience and Advantage Documentation. 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.

Form #: GID-004-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2010
Title: Appointment of Commissioner as Attorney-in-fact by Insurer
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-006-AL $This is in the Adobe Portable Document format (pdf)\n$	Division: Agents Licensing	Published: 2011
Title: Request for Clearance Letter (same as GID-AL-6)
Request for Clearance Letter

Form #: GID-006-IL $This is in the Adobe Portable Document format (pdf)\n$	Division: Industrial Loan	Published: 2012
Title: Annual Georgia Industrial Loan License Renewal
Annual Georgia Industrial Loan License Renewal Application. 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. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-007-IL $This is in the Adobe Portable Document format (pdf)\n$	Division: Industrial Loan	Published: 2008
Title: Annual Georgia Industrial Loan Report
Annual Georgia Industrial Loan Report This is an Adobe Interactive Form. You may fill it out on-line, print it and send it to us. This is an Adobe Interactive Form.

Form #: GID-007-NT(same as EN-7) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2013
Title: Vehicle Protection Warrantor - Notice and Registration - Annual Renewal Registration (same as EN-7)
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal. 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 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-007-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2001
Title: Official Having Supervision Of Insurance In The State Of Domicile
Form is to be completed by the supervising insurance official.

Form #: GID-007A-IL $This is in the Adobe Portable Document format (pdf)\n$	Division: Industrial Loan	Published: 2008
Title: Annual Georgia Industrial Loan report Addendum
This is an Adobe Interactive Form. You may fill it out on-line, print it and send it to us.

Form #: GID-007B-IL $This is in the Adobe Portable Document format (pdf)\n$	Division: Industrial Loan	Published: 2008
Title: Statement of Income and Expenses
This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-010-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Application for Renewal of Certificate of Authority
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. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-011-RS Memo $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2001
Title: Memo regarding Insurance company
Memo regarding Insurance company's Annual Statement for Publication

Form #: GID-011-RS with Reference Guide $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2010
Title: Insurance Company Annual Statement for Publication
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-012 $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2005
Title: Annual Premium Tax Return (Rev 10-05)
Annual Premium Tax Return (Rev 10-05)

Form #: GID-012 $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2007
Title: Annual Premium Tax Return
Annual Premium Tax Return (Rev 10-07)

Form #: GID-012 Instructions $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2007
Title: GID-012 Instructions
Instructions (GID-12) (Rev 10-07)

Form #: GID-012 Instructions $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2006
Title: GID-012 Instructions
GID-012 Instructions

Form #: GID-012 Instructions $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2007
Title: GID-012 Instructions
GID-012 Instructions (Rev 10-07)

Form #: GID-012 Instructions $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2005
Title: GID-12 Instructions (Rev 10-05)
GID-12 Instructions (Rev 10-05)

Form #: GID-012 Instructions $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2006
Title: GID-12 Instructions
GID-12 Instructions (Rev 10-06)

Form #: GID-012 Instructions $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2007
Title: GID-12 Instructions (Rev 10-07)
GID-12 Instructions (Rev 10-07)

Form #: GID-012-IL $This is in the Adobe Portable Document format (pdf)\n$	Division: Industrial Loan	Published: 2011
Title: Quarterly Insurance and Loan Report
This is an Adobe Interactive Form. You may fill it out on-line, print it and send it to us.

Form #: GID-012-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2009
Title: 2009 ANNUAL PREMIUM TAX RETURN (Rev 09-09)
2009 ANNUAL PREMIUM TAX RETURN (Rev 09-09). Same as GID-12.

Form #: GID-012-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2011
Title: ANNUAL PREMIUM TAX RETURN
ANNUAL PREMIUM TAX RETURN

Form #: GID-012-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2012
Title: Annual Premium Tax Return
Annual Premium Tax Return

Form #: GID-012-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2012
Title: Annual Premium Tax Return
Annual Premium Tax Return

Form #: GID-012-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2010
Title: ANNUAL PREMIUM TAX RETURN
2010 ANNUAL PREMIUM TAX RETURN(Rev 10-10). Same as GID-12.

Form #: GID-012-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2008
Title: Annual Premium Tax return
GID-12-PT 2008 ANNUAL PREMIUM TAX RETURN (Rev 10-08). Same as GID-12.

Form #: GID-012A $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2006
Title: Statement of Quarterly Premium Tax
Statement of Quarterly Premium Tax (Rev 10-06)

Form #: GID-012A $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2007
Title: Statement of Quarterly Premium Tax
Statement of Quarterly Premium Tax (Rev 10-07)

Form #: GID-012A $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2005
Title: Statement of Quarterly Premium Tax
Statement of Quarterly Premium Tax (Rev 10-05)

Form #: GID-012A-IL $This is in the Adobe Portable Document format (pdf)\n$	Division: Industrial Loan	Published: 2011
Title: Statement Of Estimated Monthly Loan Tax Report
This is an Adobe Interactive Form. You may fill it out on-line, print it and send it to us.

Form #: GID-012A-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2012
Title: STATEMENT OF QUARTERLY PREMIUM TAX
STATEMENT OF QUARTERLY PREMIUM TAX

Form #: GID-012A-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2013
Title: Statement of Quarterly Premium Tax
Statement of Quarterly Premium Tax

Form #: GID-012A-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2011
Title: STATEMENT OF QUARTERLY PREMIUM TAX
Form is provided for quarterly filings.

Form #: GID-012A-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2008
Title: Statement of Quarterly Premium Tax
STATEMENT OF QUARTERLY PREMIUM TAX (Rev 10-08)

Form #: GID-012A-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2009
Title: Statement of Quaterly Premium Tax
Statement of Quaterly Premium Tax

Form #: GID-013 $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2005
Title: Georgia Retaliatory Tax Computation
Georgia Retaliatory Tax Computation (O.C.G.A. §33-3-26) (Rev 10-05)

Form #: GID-013 $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2006
Title: Georgia Retaliatory Tax Computation - 2006
Georgia Retaliatory Tax Computation (O.C.G.A. §33-3-26) (Rev 10-06)

Form #: GID-013 $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2007
Title: Georgia Retaliatory Tax Computation
Georgia Retaliatory Tax Computation (O.C.G.A. §33-3-26) (Rev 10-07)

Form #: GID-013 Instructions $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2005
Title: Georgia Retaliatory Tax Computation
Georgia Retaliatory Tax Computation Instructions (O.C.G.A. §33-3-26) (Rev 10-05)

Form #: GID-013 Instructions $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2006
Title: Georgia Retaliatory Tax Computation
Georgia Retaliatory Tax Computation (O.C.G.A. §33-3-26)

Form #: GID-013 Instructions $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2007
Title: GID-013 instructions
GID-013 instructions (Rev1007)

Form #: GID-013 instructions $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2005
Title: GID-13 instructions (Rev 10-05)
GID-13 2005 Georgia Retaliatory Tax Computation (O.C.G.A. 33-3-26) (Rev 10-05)

Form #: GID-013-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2011
Title: GEORGIA RETALIATORY TAX COMPUTATION
GEORGIA RETALIATORY TAX COMPUTATION

Form #: GID-013-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2011
Title: GEORGIA RETALIATORY TAX COMPUTATION
GEORGIA RETALIATORY TAX COMPUTATION

Form #: GID-013-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2012
Title: GEORGIA RETALIATORY TAX COMPUTATION
GEORGIA RETALIATORY TAX COMPUTATION.

Form #: GID-013-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2010
Title: 2010 Georgia Retaliatory Tax Computation (Rev 10-10).
2010 Georgia Retaliatory Tax Computation (Rev 10-10). Same as GID-13.

Form #: GID-013-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2009
Title: 2009 Georgia Retaliatory Tax Computation (Rev 09-09)
2009 Georgia Retaliatory Tax Computation (Rev 09-09). Same as GID-13.

Form #: GID-013-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2008
Title: Georgia Retaliatory Tax Computation
Georgia Retaliatory Tax Computation (Rev 10-08)

Form #: GID-014 $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2005
Title: Calculation for Abatement of Gross Premium Tax for the Year Ending 2005
Calculation for Abatement of Gross Premium Tax for the Year Ending DECEMBER 31, 2005 (Rev 10-05)

Form #: GID-014 $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2006
Title: Calculation for Abatement of Gross Premium Tax for the Year Ending 2006
Calculation for Abatement of Gross Premium Tax for the Year Ending DECEMBER 31, 2006 (Rev 10-06)

Form #: GID-014 $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2007
Title: Calculation for Abatement of Gross Premium Tax for the Year Ending 2007
Calculation for Abatement of Gross Premium Tax for the Year Ending DECEMBER 31, 2007 (Rev1007)

Form #: GID-014 Instructions $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2006
Title: GID-014 Instructions
GID-014 Instructions (Rev 10-06)

Form #: GID-014 Instructions $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2007
Title: Instructions
Instructions (Rev 10-07)

Form #: GID-014 Instructions $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2005
Title: GID-14 Instructions (Rev 10-05)
GID-14 Instructions (Rev 10-05)

Form #: GID-014-IL $This is in the Adobe Portable Document format (pdf)\n$	Division: Industrial Loan	Published: 2009
Title: Licensee Request to Relocate
Licensee Request to Relocate. Same as IL-14.

Form #: GID-014-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2008
Title: 2008 Calculation for abatement of Gross Premium Tax
2008 Calculation for abatement of Gross Premium Tax (Rev 10-08)

Form #: GID-014-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2011
Title: CALCULATION FOR ABATEMENT OF GROSS PREMIUM
CALCULATION FOR ABATEMENT OF GROSS PREMIUM

Form #: GID-014-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2012
Title: CALCULATION FOR ABATEMENT OF GROSS PREMIUM TAX
CALCULATION FOR ABATEMENT OF GROSS PREMIUM TAX

Form #: GID-014-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2010
Title: 2010 Calculation For Abatement Of Gross Premium Tax
2010 Calculation For Abatement Of Gross Premium Tax (Rev 10-10). Same as GID-14.

Form #: GID-014-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2009
Title: 2009 Calculation For Abatement Of Gross Premium Tax (Rev 09-09)
2009 Calculation For Abatement Of Gross Premium Tax (Rev 09-09). Same as GID-14.

Form #: GID-014-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2008
Title: 2008 Calculation For Abatement Of Gross Premium Tax
2008 Calculation For Abatement Of Gross Premium Tax (Rev 10-08)

Form #: GID-014-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2008
Title: Calculation for Abatement of Gross Premium Tax
Calculation for Abatement of Gross Premium Tax (Rev 10-08)

Form #: GID-015 $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2006
Title: Statement in Support of Claim for Retaliatory Tax Credits
Statement in Support of Claim for Retaliatory Tax Credits (Rev 10-06)

Form #: GID-015 $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2007
Title: Statement in Support of Claim for Retaliatory Tax Credits
Statement in Support of Claim for Retaliatory Tax Credits (Rev 10-07)

Form #: GID-015 $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2005
Title: Statement in Support of Claim for Retaliatory Tax Credits
Statement in Support of Claim for Retaliatory Tax Credits (Rev 10-05)

Form #: GID-015-IL $This is in the Adobe Portable Document format (pdf)\n$	Division: Industrial Loan	Published: 2012
Title: Loan Managers Appointment Form
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-015-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2010
Title: 2010 Statement In Support Of Claim For Retaliatory Tax Credtis
2010 Statement In Support Of Claim For Retaliatory Tax Credtis (Rev 10-10). Same as GID-15

Form #: GID-015-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2009
Title: 2009 Statement In Support Of Claim For Retaliatory Tax Credits
2009 Statement In Support Of Claim For Retaliatory Tax Credits. Same as GID-15.

Form #: GID-015-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2011
Title: STATEMENT IN SUPPORT OF CLAIM FOR RETALIATORY TAX CREDITS
STATEMENT IN SUPPORT OF CLAIM FOR RETALIATORY TAX CREDITS

Form #: GID-015-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2012
Title: STATEMENT IN SUPPORT OF CLAIM FOR RETALIATORY TAX CREDITS
STATEMENT IN SUPPORT OF CLAIM FOR RETALIATORY TAX CREDITS

Form #: GID-015-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2008
Title: 2008 Statement In Support Of Claim For Retaliatory Tax Credits
2008 Statement In Support Of Claim For Retaliatory Tax Credits (Rev 10-08)

Form #: GID-016-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2010
Title: Affidavit of Investment by Domiciliary Insurers
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-017A $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2005
Title: Municipal License Fees Form
Municipal License Fees Form - Rev 10-05

Form #: GID-017A $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2006
Title: Municipal License Fees Form
Municipal License Fees Form. Rev 10-06

Form #: GID-017A $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2007
Title: Municipal License Fees Form
Municipal License Fees Form (LIFE, A and S, AND HMO COMPANIES ONLY). Rev 10-07

Form #: GID-017A-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2012
Title: MUNICIPAL LICENSE FEES FORM
MUNICIPAL LICENSE FEES FORM

Form #: GID-017A-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2010
Title: 2010 MUNICIPAL LICENSE FEES FORMS
2010 MUNICIPAL LICENSE FEES FORMS (Rev 11-10). Same as GID-17A.

Form #: GID-017A-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2011
Title: MUNICIPAL LICENSE FEES FORM
MUNICIPAL LICENSE FEES FORM

Form #: GID-017A-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2009
Title: 2009 MUNICIPAL LICENSE FEES FORMS (Rev 9-09)
2009 MUNICIPAL LICENSE FEES FORMS (Rev 9-09). Same as GID-17A.

Form #: GID-018-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2010
Title: Initial Statement of Beneficial Ownership of Equity Securities
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-019-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2010
Title: Statement Of Changes In Beneficial Ownership Of Equity Securities
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-021-EN JAN2012 $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Application For A License As An Insurance Premium Finance Company
This application form is required for Insurance Premium Finance Companies requesting approval for a license to operate in the State of Georgia. 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-022-EN JAN2012 $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Application For Renewal License As An Insurance Premium Finance Company
Annual Renewal Licensing form used by Premium Finance Companies. 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-023-EN DEC09 $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Biographical Questionnaire For Premium Finance Companies
The Biographical Questionnaire must be completed by Affiants of Premium Finance Companies. 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-024-EN DEC09 $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Annual Report Of Insurance Premium Finance Companies
Insurance Premium Finance Companies are required to file this form with the department annually. 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.

Form #: GID-028-EN DEC09 $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Insurance Premium Finance Company Bond
This bond is required of Insurance Premium Finance Companies to operate within the state. Instructions are included with the form. This bond form requires the Licensee's and Surety's seals to be affixed. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-032-NT $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Application for License as a Prepaid Legal Services Sponsor
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-033-NT (same as GID-33) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Application for Renewal License as a Prepaid Legal Service Sponsor
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-034 $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Bond by Sponsor of Prepaid Legal Services Plan
Bond by Sponsor of Prepaid Legal Services Plan

Form #: GID-035 $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Power to Sell and Assign Securities Deposited with the Commissioner of Insurance
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-036 $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Resolution Form Authorizing Sale or Assignment
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-037 $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Authorization Form For Sale or Assignment
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-037-C $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Assignment of Savings Share Certificate or CD
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-038 $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Assignment of Savings Share Certificate or Certificate of Deposit
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-039 $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Annual Report of Prepaid Legal Services Sponsor
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-040-EN DEC09 $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Insurance Premium Finance Company Convenience And Advantage Form
This form is submitted by companies to request approval for operating as an Insurance Premium Finance Company within the state. Instructions are included with the form. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-041 $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Biographical Questionnaire
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-042-RS Exhibit K $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2010
Title: Property and Casualty Insurers 384 Annual Report
This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-043-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2010
Title: Automobile Self-Insurer Bond Form
Automobile Self-Insurer Bond Form and Instructions

Form #: GID-044-RS Exhibit L - GA Business $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2010
Title: Georgia Property and Casualty Insurance Information (Exhibit L - GA Business Only)
This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-045-RS Exhibit L - Countrywide $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2010
Title: Georgia Property and Casualty Insurance Information (Exhibit L - Countrywide)
This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-050-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2009
Title: 2009 LIFE HEALTH GUAR FUND TAX CREDIT
2009 LIFE HEALTH GUAR FUND TAX CREDIT . (Same as GID-50)

Form #: GID-050-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2012
Title: 2012 Life and Health Guaranty Fund Tax Credit
2012 Life and Health Guaranty Fund Tax Credit

Form #: GID-050-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2011
Title: 2011 LIFE AND HEALTH GUARANTY FUND TAX CREDIT FORM
2011 LIFE AND HEALTH GUARANTY FUND TAX CREDIT FORM

Form #: GID-050-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2010
Title: 2010 LIFE HEALTH GUAR FUND TAX CREDIT
2010 LIFE HEALTH GUAR FUND TAX CREDIT (Rev 10-10). Same as GID-50.

Form #: GID-050-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2008
Title: Life and Health Guaranty Fund Tax Credit form
Life and Health Guaranty Fund Tax Credit form. (Rev 10-08)

Form #: GID-051-NT (same as GID-051-EN) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Application For License As An Administrator
This form is submitted by companies to make application as a TPA Administrator. Instructions are included with the form. 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-052-NT (same as GID-052-EN) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Biographical Statement And Affidavit
This form is used to provide biographical information on individuals where required. 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.

Form #: GID-053-NT (same as GID-053-EN) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Authority For Release Of Information
This form is submitted to authorized the Office of Commissioner of Insurance to conduct a background investigation. 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.

Form #: GID-054-NT (same as GID-054-EN) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Service Of Process Consent And Agreement
This form is used to designate the person to be served for transactions that require official notification. 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.

Form #: GID-055-NT (same as GID-055-EN) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Resolution Form
This form is used by a corporation to designate officers empowered to act on behalf of the corporation. The corporate seal must be affixed to the document. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-056-NT (same as GID-056-EN) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Financial Statement
This form is used to provide annual financial information about the entity. 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.

Form #: GID-057-LH-UR $This is in the Adobe Portable Document format (pdf)\n$	Division: Product Review	Published: 2012
Title: Application For Certification as a Private Review Agent
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. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-057-NT (same as GID-057-EN) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Bond
This form is used by Administrators to meet the established bond requirements. 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.

Form #: GID-059-NT $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 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 $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
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 $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 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 $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 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-063-PC (same as GID-63) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: DISCLOSURE STATEMENT
For Experience Rating Notification By Workers' Compensation Carriers.

Form #: GID-065-LH-UR $This is in the Adobe Portable Document format (pdf)\n$	Division: Life & Health	Published: 2011
Title: Biographical Affidavit
Biographical Affidavit

Form #: GID-072-LH-UR Certification Checklist $This is in the Adobe Portable Document format (pdf)\n$	Division: Life & Health	Published: 2012
Title: Checklist of Application Documents for initial Certification of Private Review Agents
Checklist of Application Documents for initial Certification of Private Review Agents.

Form #: GID-073-LH-UR $This is in the Adobe Portable Document format (pdf)\n$	Division: Life & Health	Published: 2011
Title: Annual Report Information for Utiltization Review Activities fot he Year Ended ...
Annual Report Information for Utiltization Review Activities fot he Year Ended ...

Form #: GID-080-NT $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Application For License As A Health Plan Purchasing Cooperative (same as GID-80)
Application is hereby made for a License to operate as a Health Plan Purchasing Cooperative (“HPPC”) pursuant to the Laws of Georgia. 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, 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.

Form #: GID-101E $This is in the Adobe Portable Document format (pdf)\n$	Division: Agents Licensing	Published: 2011
Title: GID-101E Request for Continuing Education Reduction Exemption
GID-101E Request for Continuing Education Reduction Exemption

Form #: GID-103-AL MARCH 2013 $This is in the Adobe Portable Document format (pdf)\n$	Division: Agents Licensing	Published: 2013
Title: Resident Insurance 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. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-110-AL $This is in the Adobe Portable Document format (pdf)\n$	Division: Agents Licensing	Published: 2012
Title: Request for Approval of Pre-Licensing or Continuing Education
Form used for obtaining New/Renewal, Pre-Licensing/Continuing Education, Course/Instructor approval. Effective 1-1-2012, the Citizenship Affidavit Form GID-276-EN must be submitted with this application for processing. 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.

Form #: GID-111-AL $This is in the Adobe Portable Document format (pdf)\n$	Division: Agents Licensing	Published: 2011
Title: Certificate of Education Completion
Provides verification of educational compliance. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-112-AL $This is in the Adobe Portable Document format (pdf)\n$	Division: Agents Licensing	Published: 2011
Title: Insurance Counselor Bond
This form requires a seal to be affixed to the document. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-113-AL $This is in the Adobe Portable Document format (pdf)\n$	Division: Agents Licensing	Published: 2011
Title: Public Adjuster Bond
This form requires a seal to be affixed to the document. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-114-AL $This is in the Adobe Portable Document format (pdf)\n$	Division: Agents Licensing	Published: 2011
Title: Surplus Lines Broker
This form requires a seal to be affixed to the document. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-12 $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2006
Title: GID-12 Annual Premium Tax Return (Rev 10-06).pdf
Annual Statement of Quarterly Premium Tax

Form #: GID-12-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2005
Title:

Form #: GID-122A/122T $This is in the Adobe Portable Document format (pdf)\n$	Division: Agents Licensing	Published: 2011
Title: Request for New and Terminated Certificate of Authority
Request for New and Terminated Certificate of Authority

Form #: GID-122SA/122TSA $This is in the Adobe Portable Document format (pdf)\n$	Division: Agents Licensing	Published: 2011
Title: GID-122sa Request for New and Terminated Subagent Certificate of Authority
GID-122sa Request for New and Terminated Subagent Certificate of Authority

Form #: GID-12A-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2004
Title:

Form #: GID-13 Instructions $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2007
Title: GID-13 Instructions (Rev10-07)
GID-13 Georgia Retaliatory Tax Computation (O.C.G.A. 33-3-26).

Form #: GID-14-2006 $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2006
Title: Calculation for Abatement of Gross Premium Tax for the Year Ending DECEMBER 31, 2006
Calculation for Abatement of Gross Premium Tax for the Year Ending DECEMBER 31, 2006

Form #: GID-14-2007 $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2007
Title: GID-14 Calculation for Abatement of Gross Premium Tax for the Year Ending DECEMBER 31, 2007
GID-14 Calculation for Abatement of Gross Premium Tax for the Year Ending DECEMBER 31, 2007 (Rev 10-07)

Form #: GID-15-2006 $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2006
Title: GID-15 Statement in Support of Claim for Retaliatory Tax Credits (Rev 10-06).pdf
GID-15 2006 Statement in Support of Claim for Retaliatory Tax Credits (Rev 10-06).pdf

Form #: GID-15-2007 $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2007
Title: GID-15 Statement in Support of Claim for Retaliatory Tax Credits (Rev 10-07).pdf
GID-15 2007 Statement in Support of Claim for Retaliatory Tax Credits (Rev 10-07).pdf

Form #: GID-17A-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2008
Title: 2008 Municipal License Fees
2008 Municipal License Fees (Rev 10-08)

Form #: GID-203-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2012
Title: RECONCILIATION STATEMENT ANNUAL PREMIUM TAX RETURN
RECONCILIATION STATEMENT ANNUAL PREMIUM TAX RETURN

Form #: GID-203-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2010
Title: 2010 RECONCILIATION STATEMENT ANNUAL PREMIUM TAX RETURN
2010 RECONCILIATION STATEMENT ANNUAL PREMIUM TAX RETURN (Rev.10-10)

Form #: GID-203-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2011
Title: RECONCILIATION STATEMENT ANNUAL PREMIUM TAX RETURN
RECONCILIATION STATEMENT ANNUAL PREMIUM TAX RETURN

Form #: GID-203-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2011
Title: RECONCILIATION STATEMENT ANNUAL PREMIUM TAX RETURN
RECONCILIATION STATEMENT ANNUAL PREMIUM TAX RETURN

Form #: GID-203-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2009
Title: 2009 RECONCILIATION STATEMENT ANNUAL PREMIUM TAX RETURN
2009 RECONCILIATION STATEMENT ANNUAL PREMIUM TAX RETURN (Rev.09-09).

Form #: GID-203-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2008
Title: Reconciliation statement annual premium tax return
GID-203-PT SEP08 2008 RECONCILIATION STATEMENT ANNUAL PREMIUM TAX RETURN

Form #: GID-205-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2012
Title: 2012 INSURANCE PREMIUM TAX CREDITS
2012 INSURANCE PREMIUM TAX CREDITS

Form #: GID-205-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2011
Title: 2011 INSURANCE PREMIUM TAX CREDITS
2011 INSURANCE PREMIUM TAX CREDITS

Form #: GID-205-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2010
Title: 2010 INSURANCE PREMIUM TAX CREDITS
INSURANCE PREMIUM TAX CREDITS

Form #: GID-205-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2009
Title: INSURANCE PREMIUM TAX CREDITS
INSURANCE PREMIUM TAX CREDITS

Form #: GID-205-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2008
Title: Insurance premium tax credits
GID-205-PT 2008 INSURANCE PREMIUM TAX CREDITS

Form #: GID-207-PT $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2012
Title: Georgia Job Tax Credit
Georgia Job Tax Credit

Form #: GID-207-PT Instructions $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2008
Title: GID-207-PT Instructions
GID-207-PT Instructions

Form #: GID-210-NT (same as GID-210-EN) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Risk Retention Group Notice and Registration
Annual Risk Retention Group Notice and Registration. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal. This is an Adobe Interactive Form. You may fill it out on-line, 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-211-NT (same as GID-211-EN) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Purchase Group Notice and Registration
Annual Risk Purchase Group Notice Registration. 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-213-PT $This is a Microsoft Excel Aplication\n$	Division: Premium Tax	Published: 2012
Title: GEORGIA RETALIATORY TAX-Interactive (O.C.G.A. § 33-3-26)
GEORGIA RETALIATORY TAX-Interactive (O.C.G.A. § 33-3-26)

Form #: GID-217A-SF / GID-217B-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2011
Title: Water Based Fire Protection Systems Inspection Waiver Affidavit and Inspector Waiver Request Holder
Contains WAIVER AFFIDAVIT (Part A) and WAIVER REQUEST (Part B). This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-220-IL $This is a Microsoft Word Document\n$	Division: Industrial Loan	Published: 2009
Title: Industrial Loan Complaint Form - May 2009
Industrial Loan Complaint Form - May 2009 (Microsoft Word)

Form #: GID-220-IL $This is in the Adobe Portable Document format (pdf)\n$	Division: Industrial Loan	Published: 2009
Title: Industrial Loan Complaint Form
Industrial Loan Complaint Form. This is an Adobe Interactive Form. You may fill it out on-line, print it and send it to us.

Form #: GID-222-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2011
Title: Water Based Fire Protection Certificate of Competency
Water Based Fire Protection Certificate of Competency and Certification of Employer License

Form #: GID-222-SF (effective 1-1-2012) $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2012
Title: Water Based Fire Protection Certificate of Competency
Water Based Fire Protection Inspector Application and Certification of Employer Inspector License. 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-223-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2011
Title: Water Based Fire Protection Designers Application
Water Based Fire Protection Designers Application

Form #: GID-223-SF (effective 1-1-2012) $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2012
Title: Water Based Fire Protection Application
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-224-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2011
Title: Water Based Fire Protection Inspector Application
2010 Water Based Fire Protection Inspector Application and Certification of Employer Inspector License.

Form #: GID-224-SF (effective 1-1-2012) $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2012
Title: Water Based Fire Protection Inspector Application
2012 Water Based Fire Protection Inspector Application and Certification of Employer Inspector License. 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-225-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2011
Title: Water Based Fire Protection Systems Contractors License
Water Based Fire Protection Systems Contractors License

Form #: GID-225-SF (effective 1-1-2012) $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2012
Title: Water Based Fire Protection Systems Contractors License
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-226-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2011
Title: Engineered Fire Suppression System License Application
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-226-SF (effective 1-1-2012) $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2012
Title: ENGINEERED FIRE SUPPRESSION SYSTEM LICENSE APPLICATION
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-227-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2011
Title: Pre-Engineered Industrial Permit Application
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-227-SF (effective 1-1-2012) $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2012
Title: Pre-Engineered Industrial Permit Application
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-228-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2011
Title: Pre-Engineered Industrial License Application
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-228-SF (effective 1-1-2012) $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2012
Title: Pre-Engineered Industrial License Application
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-229-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2011
Title: PROVISIONAL PERMIT APPLICATION
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-229-SF (effective 1-1-2012) $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2012
Title: Provisional Permit Application
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-230-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2011
Title: Engineered Fire Suppression System Permit Application
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-230-SF (effective 1-1-2012) $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2012
Title: Engineered Fire Suppression System Permit Application
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-231-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2011
Title: Portable Fire Extinguisher License Application
Portable Fire Extinguisher License Application. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-231-SF (effective 1-1-2012) $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2012
Title: Portable Fire Extinguisher License Application
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-232-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2011
Title: Portable Fire Extinguisher Permit Application
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-232-SF (effective 1-1-2012) $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2012
Title: Portable Fire Extinguisher Permit Application
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-233-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2011
Title: Pre-Engineered Kitchen Restaurant Fire Suppression System Permit Application
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-233-SF (effective 1-1-2012) $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2012
Title: Pre-Engineered Kitchen Restaurant Fire Suppression System Permit Application
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-234-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2011
Title: Pre-Engineered Kitchen Restaurant Fire Suppression System License Application
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-234-SF (effective 1-1-2012) $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Engineering & Inspections	Published: 2012
Title: Pre-Engineered Kitchen Restaurant Fire Suppression System License Application
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-237-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Manufactured Housing	Published: 2011
Title: Georgia Manufactured Homes Retailer Retail Broker Acknowledgment
Georgia Manufactured Homes Retailer Retail Broker Acknowledgment Form, Installation Notice Form, and Retailer Retail Broker Monthly Requirement Form.

Form #: GID-238-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Manufactured Housing	Published: 2013
Title: Manufactured Housing Installation Information Form (Same as FM-391)
Manufactured Housing Installation Information Form (Same as FM-391). This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-239-NT (same as GID-239-EN) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2013
Title: Annual Renewal Check Sheet For Groups
Used by Groups to provide contact information specific to the Group. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-242-NT (same as GID-242-EN) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2013
Title: Third Party Administrator Notice Of Exemption
This form is used to claim an annual exemption as a Third Party Administrator. 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.

Form #: GID-243A-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Hazardous Materials	Published: 2012
Title: Application for Proximate Audience License Fireworks and or Pyrotechnic Displays
Effective 1-1-2012, the Citizenship Affidavit Form GID-276-EN must be submitted with this application for processing.

Form #: GID-243B-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Hazardous Materials	Published: 2011
Title: Qualification Form for Fireworks and or Pyrotechnic Assistants.
Qualification Form for Fireworks and or Pyrotechnic Assistants.

Form #: GID-243C-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Hazardous Materials	Published: 2011
Title: Qualification Form for Fireworks and or Pyrotechnic Operators
Qualification Form for Fireworks and or Pyrotechnic Operators

Form #: GID-244-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Hazardous Materials	Published: 2012
Title: Racetrack License Application
Effective 1-1-2012, the Citizenship Affidavit Form GID-276-EN must be submitted with this application for processing.

Form #: GID-245-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Hazardous Materials	Published: 2012
Title: Application for License to Manufacture and/or Store Fireworks and/or Pyrotechnics
Effective 1-1-2012, the Citizenship Affidavit Form GID-276-EN must be submitted with this application for processing.

Form #: GID-246-SF (same as SFD-46) $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Hazardous Materials	Published: 2012
Title: Anhydrous Ammonia Application
Effective 1-1-2012, the Citizenship Affidavit Form GID-276-EN must be submitted with this application for processing.

Form #: GID-247-SF (same as SFD-389) $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Hazardous Materials	Published: 2012
Title: Application for Compressed Natural Gas Construction and/or Operations Permit
CNG Construction and or Operation Permit. Effective 1-1-2012, the Citizenship Affidavit Form GID-276-EN must be submitted with this application for processing.

Form #: GID-248A-SF (same as SFD-29) $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Hazardous Materials	Published: 2012
Title: Liquefied Petroleum Gas License Application
Effective 1-1-2012, the Citizenship Affidavit Form GID-276-EN must be submitted with this application for processing.

Form #: GID-253-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2010
Title: Fees Statement And Transmittal Voucher
Serves as the annual renewal fees proof of payment. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

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. 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.

Form #: GID-255-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 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-256-NT (same as GID-256-EN) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Application for New and Renewal License As Pharmacy Benefits Managers
Application is hereby made for a License to operate as a Pharmacy Benefits Manager pursuant to the Laws of Georgia. 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-257-NT $This is in the Adobe Portable Document format (pdf)\n$	Division: Enforcement	Published: 2011
Title: Verification of Coverage
Form includes requirements for Insurance Companies and Life Settlement Providers/Producers.

Form #: GID-259-RS (same as SYNOPSIS) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Synopsis Of Requirement To Form A Workers Compensation Group Self-Insurance Fund
Synopsis Of Requirement To Form A Workers Compensation Group Self-Insurance Fund.

Form #: GID-260-RS (same as GSF-IN) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Notice Of Intent To Form A Group Self-Insurance Fund
Notice Of Intent To Form A Group Self-Insurance Fund. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-261-RS JAN2012 (same as GSF-1) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Application For Certificate Of Authority For Group Self-Insurance Fund
Application is hereby for Certificate Of Authority For 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.

Form #: GID-262-RS (same as GSF-12) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Group Self-Insurance Surplus Bond
Group Self-Insurance Surplus Bond.

Form #: GID-263-RS JAN2012 (same as GSF-3) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
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.

Form #: GID-264-RS (same as GSF-4) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Application For Termination Of Membership In Group Self-Insurance Fund
Application For Termination Of Membership In Group Self-Insurance Fund. 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-265-RS (same as GSF-5) $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Applic To Serve As Officer Director Or Trustee Of Group Self-Insurance Fund
Application is hereby made to serve as Officer, Director or Trustee of Group Self-Insurance Fund.

Form #: GID-266-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Application To Serve As Administrator Of Group Self-Insurance Fund - (same as GSF-6)
Application To Serve As Administrator Of Group Self-Insurance Fund. 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.

Form #: GID-267-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Group Self-Insurance Bond (same as GSF-7)
Group Self-Insurance Bond.

Form #: GID-268-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Administers Fidelity Bond For Group Self-Insurance (same as GSF-8)
Administers Fidelity Bond For Group Self-Insurance.

Form #: GID-269-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Resolution Form Authorizing Sale Or Assignment Of Securities (same as GSF-9)
Resolution Form Authorizing Sale Or Assignment Of Securities. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-270-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Assignment of Savings Share Certificate or Certificate of Deposit (same as GSF-10)
Assignment of Savings Share Certificate or Certificate of Deposit. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-271-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2011
Title: Power To Sell and Assign Securities Deposited With The Commissioner of Insurance (same as GSF-11)
Power To Sell and Assign Securities Deposited With The Commissioner of Insurance (same as GSF-11). This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-273-SF $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Hazardous Materials	Published: 2011
Title: Application For Permit To Conduct Outdoor Fireworks and/or Pyrotechnics Displays
Permission to conduct outdoor fireworks and/or pyrotechnics displays. 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-279-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Application To Serve As Administrator Of Captive Insurance Company - same as CAP-3
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-280-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Biographical Questionnaire For Captive Insurance Company - same as CAP-4
This form is required of persons holding a position as a company officer.

Form #: GID-281-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Resolution Form Authorizing Sale Or Assignment Of Securities - same as CPA-5
This form specifies the wording to be used in the resolution for authorizing sale or assignment of securities. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-282-RS $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: Assignment Of Savings Share Certificate Or Certificate Of Deposit - same as CAP-6
This form is used to assign and transfer certificate funds to the Insurance Commissioner.

Form #: GID-283-NT $This is in the Adobe Portable Document format (pdf)\n$	Division: Enforcement	Published: 2012
Title: Pharmacy Benefits Manager Notice Of Affiliation
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.

Form #: GID-360-NT JAN2013 $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2013
Title: Pharmacy Benefits Managers Renewal Check Sheet
Annual filing renewal check sheet instructions. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-362-NT JAN2013 $This is in the Adobe Portable Document format (pdf)\n$	Division: Enforcement	Published: 2013
Title: Filing Instructions For Life Settlement Providers Renewals And Check Sheet
Annual Statement Filing Instructions for Licensed Life Settlement Providers. This Check Sheet is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.

Form #: GID-AL-LS-1 $This is in the Adobe Portable Document format (pdf)\n$	Division: Agents Licensing	Published: 2012
Title: Life Settlement Producer Registration
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-AL-RC-1 $This is in the Adobe Portable Document format (pdf)\n$	Division: Agents Licensing	Published: 2012
Title: Rental Company License Application
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-FO-PT-2 $This is in the Adobe Portable Document format (pdf)\n$	Division: Premium Tax	Published: 2007
Title: Interactive Risk Retention Group (Rev 12-07)
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-NT-LS-1 $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2012
Title: New and Renewal Application for License as a Life Settlement Provider (same as GID-EN-LS-1)
This application is for new and renewal Life Settlement Provider applicants (which were previously separate forms). Refer to the instructions for new and renewal applications. 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 for processing. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-NT-LS-1 $This is in the Adobe Portable Document format (pdf)\n$	Division: Enforcement	Published: 2011
Title: Filing Instructions For Life Settlement Licensure (same as GID-EN-LS-1) Instructions For New Applicants
Contains a Cover Letter and Instructions. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-PPA1 $This is in the Adobe Portable Document format (pdf)\n$	Division: Life & Health	Published: 2011
Title: Patient Protection Act Application for Certification
This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: GID-SF-RIFR-001 $This is in the Adobe Portable Document format (pdf)\n$	Division: Safety Fire - Hazardous Materials	Published: 2011
Title: Racetrack Incident Report
Racetrack Incident Report

Form #: Risk Purchasing Groups Annual Renewal Instructions $This is in the Adobe Portable Document format (pdf)\n$	Division: Regulatory Services	Published: 2013
Title: Purchasing Groups- Annual Renewal Memo (same as GID-211-EN Memo)
Memo for Annual Risk Purchasing Groups registration

Form #: UANRBEILR JAN2013 $This is in the Adobe Portable Document format (pdf)\n$	Division: Agents Licensing	Published: 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.

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