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CAPTIVES - For Prospective Captive Managers



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:3066-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:2905-FN:GID-276-EN.pdf

Form #GID-279-RS This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2015
Title: Application to Serve as Manager of 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:812-SID:1713-FN:GID-279-RS.pdf

Form #GID-415-RS This is in the Adobe Portable Document format (pdf)\nDivision: Insurance Financial OversightPublished: 2015
Title: Biographical Affidavit with Background Reports for Captive Manager
Biographical Affidavit with Background Reports for Captive Manager
PID:1138-SID:2946-FN:GID-415-RS.pdf

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