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Premium Finance Companies



Form #GID-021-NT This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2019
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.
PID:638-SID:1004-FN:GID-021-EN.pdf

Form #GID-022-NT This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 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.
PID:635-SID:1001-FN:GID-022-EN.pdf

Form #GID-023-NT This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 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.
PID:637-SID:1003-FN:GID-023-EN.pdf

Form #GID-024-NT This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 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.
PID:646-SID:1012-FN:GID-024-EN.pdf

Form #GID-028-NT.pdf This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2019
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. 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.
PID:1245-SID:3242-FN:GID-028-NT.pdf

Form #GID-040-NT This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2019
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.
PID:205-SID:71-FN:GID-040-EN.pdf

Form #GID-053-NT This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2015
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.
PID:650-SID:1016-FN:GID-053-NT.pdf

Form #GID-276-EN This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2015
Title: Citizenship Affidavit
Effective 1-1-2012, this form is required of persons making application for all licenses, permits, registrations and certifications in order to comply with the Georgia Illegal Immigration Reform And Enforcement Act. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.
PID:788-SID:1691-FN:GID-276-EN.pdf

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