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| Form Number: Citizenship Affidavit GID-276-EN |  | | Title: Citizenship Affidavit | Published: 2013 | | Description: 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 Number: GID-051-NT (same as GID-051-EN) |  | | Title: Application For License As An Administrator | Published: 2012 | | Description: 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 Number: GID-052-NT (same as GID-052-EN) | | | Title: Biographical Statement And Affidavit | Published: 2012 | | Description: 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 Number: GID-053-NT (same as GID-053-EN) | | | Title: Authority For Release Of Information | Published: 2011 | | Description: 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 Number: GID-054-NT (same as GID-054-EN) | | | Title: Service Of Process Consent And Agreement | Published: 2011 | | Description: 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 Number: GID-055-NT (same as GID-055-EN) | | | Title: Resolution Form | Published: 2011 | | Description: 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 Number: GID-056-NT (same as GID-056-EN) | | | Title: Financial Statement | Published: 2011 | | Description: 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 Number: GID-057-NT (same as GID-057-EN) | | | Title: Bond | Published: 2011 | | Description: 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 Number: GID-242-NT (same as GID-242-EN) | | | Title: Third Party Administrator Notice Of Exemption | Published: 2013 | | Description: 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 Number: GID-363-NT JAN2013 | | | Title: TPA Annual Statements Filing Instructions And Check Sheet | Published: 2013 | | Description: Contains information pertaining to the requirements of Third Party Administrators for filing with the department. This Check Sheet is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us. |
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