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Life Settlement Providers Forms

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Form #: GID-052-NT (same as GID-052-EN) This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 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)\nDivision: Insurance Financial OversightPublished: 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)\nDivision: Insurance Financial OversightPublished: 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)\nDivision: Insurance Financial OversightPublished: 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)\nDivision: Insurance Financial OversightPublished: 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-257-NT This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2011
Title: Verification of Coverage
Form includes requirements for Insurance Companies and Life Settlement Providers/Producers.

Form #: GID-276-EN This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2014
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-362-NT This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2015
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-NT-LS-1 This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2015
Title: New and Renewal Application for License as a Life Settlement Provider
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 Instructions Letter This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2015
Title: Instructions Letter for New and Renewal Application for License as a Life Settlement Provider
Instructions Letter for New and Renewal Application for License as a Life Settlement Provider

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