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Citizenship Affidavit and Verifiable Identification Document Instructions

for Agencies

Due to the passage of the Illegal Immigration Reform and Enforcement Act of 2011, the Georgia Department of Insurance is required to verify the lawful presence of all new and renewal applicants subject to licensure by the Department of Insurance. This includes Agents and Agencies for new and renewal submissions. Your license cannot be renewed, and a new license cannot be issued if this information is not submitted correctly. This page has been developed to provide you with information and instruction on how to easily comply with this requirement.


In order to comply with this requirement, an Authorized Employee or Officer of the Agency must:

1) Print, complete, sign, and notarize The Citizenship Affidavit Form GID-276-EN

2) Submit the form along with a copy of the front AND back of one of the secure and verifiable identification documents listed on the form.


Submission can be done after completing and paying for your renewal online via Vertafore (formerly Sircon) or NIPR.  Transmit your documents by one of the following methods, in order of preference:

1)   Most Preferred Method - Upload your document via the Georgia Agency Portal - The Georgia Agent Portal from the Georgia Department of Insurance's web site is the most preferred, secure, and reliable method of submitting your information. It has been developed specifically for easily uploading your scanned or photographed files, and will give you the fastest response time if there is a problem with your submission.

2)   Email - You may email your documents as attachments to:

3)   Fax - You can fax your documents to 404-656-0874. This is not the preferred method, due to clarity issues and delayed processing time if there is a problem with your submission; resulting in delayed renewal or approval.

4)   U.S. Mail - Mailing your documents is the least preferred method and will be the slowest from a processing standpoint.  You can mail your documents to:


Mailing Address Without Payments Mailing Address With Payments
PSI Services LLC
2997 Cobb Parkway SE,
P.O. Box 723957,
Atlanta, GA 31139
Bank of America Lockbox Services,
Lockbox 742983, 6000 Feldwood Road,
College Park, GA 30349

Due to the delay in the mail process, and having to physically join paper files, it could take much longer before your license renewal is confirmed, or you are notified of problems with your renewal.


o Use the Georgia Agency Portal

o Simply take a picture of the ID documentation with your smart phone.  We have found pictures to be of higher clarity and easier for many users to upload.  Some camera phones work well enough to use for the form as well, but we must be able to read the notary information for it to pass review. If your camera phone will not take a picture clear enough to read all letters and symbols, then scan the form.

o Read the ALL the instructions on the form. Make sure you get it right the first time. Incorrect submissions could result in renewal delays, fines, or penalties.

o Check your Agent Profile to be certain you renewed. We want to help you any way we can, but ultimately it is your responsibility to be certain you are renewed before the deadline. The easiest way to make sure your renewal was processed is to check the Agency Search feature on the Department web-site.

o Don’t forget about your CE requirements. Your license will not be renewed until all of your CE is completed. View the CE requirements on the Department website. You can check to be certain of your credited hours on your Agent Profile from the Agency Search feature on the Department web-site.

o If applying on behalf of a business entity (Agency), then an employee or officer of the business entity, who has authority, must complete and submit these documents.

o If you (or, for a business entity, the employer or officer with authority) are not a United States citizen, we are required by law to verify your immigration status through the Federal Systematic Alien Verification of Entitlement (SAVE) program.

o The Citizenship affidavit form contains a list of ALL secure and verifiable documents that this Office can accept in order to satisfy this requirement. We cannot accept any documents that are not included in this list.

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