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Captives - For Newly Forming Captives



Form #GID-130C-RS This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2016
Title: Request for Captive Name Approval
Request for Captive Name Approval, as a part of the application to become an approved captive manager in the State of Georgia. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.
PID:1173-SID:3064-FN:GID-130C-AL.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:2935-FN:GID-276-EN.pdf

Form #GID-278-RS This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2015
Title: Application For Certificate Of Authority For Captive Insurance Company
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.
PID:810-SID:2939-FN:GID-278-RS.pdf

Form #GID-280-RS This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2015
Title: Biographical Affidavit For Captive Insurance Company
This form is required of persons holding a position as a company officer.
PID:813-SID:2940-FN:GID-280-RS.pdf

Form #GID-412-RS This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2015
Title: Biographical Affidavit with Background Reports for Captive Insurance Company
Biographical Affidavit with Background Reports for Captive Insurance Company
PID:1135-SID:2947-FN:GID-412-RS.pdf

Form #GID-423-RS This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2016
Title: Application Checklist for A Newly Forming Captive Insurance Company
Application Checklist for A Newly Forming Captive Insurance Company. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.
PID:1179-SID:3062-FN:GID-423-RS.pdf

Form #GID-424-RS This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2016
Title: Plan of Operation Checklist for A Newly Forming Captive Insurance Company
Plan of Operation Checklist for A Newly Forming Captive Insurance Company. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.
PID:1180-SID:3063-FN:GID-424-RS.pdf

Form #GID-449-RS This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2019
Title: Application for Authorization to Certify Reserves for Captives
This form is required of persons seeking authorization to certify loss reserves and loss expense reserves for captives. The Biographical Affidavit Form GID-280-RS must be submitted with this application for processing.
PID:1244-SID:3240-FN:GID-449-RS.pdf

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