Office of Insurance and Safety Fire CommissionerRalph T. Hudgens
Commissioner
Home Agents Insurers Fire Marshal Industrial Loan Consumer Services Premium Tax Enforcement Fraud

Consumer Services Forms

Form #: APP-ASSIGN This is in the Adobe Portable Document format (pdf)\nDivision: Consumer ServicesPublished: 2012
Title: Individual Eligibility Application for the State of Georgia Assignment System
Effective 1-1-2012, the Citizenship Affidavit Form GID-276-EN must be submitted with the application to be processed. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.

Form #: Citizenship Affidavit GID-276-EN This is in the Adobe Portable Document format (pdf)\nDivision: Consumer ServicesPublished: 2012
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.

Form #: GID-258-LH (same as Provider Instructions) This is in the Adobe Portable Document format (pdf)\nDivision: Consumer ServicesPublished: 2011
Title: Provider Complaint Form
Please use this Provider Complaint Form when Mailing your Insurance issues into the Department.

Form #: GID-CS-CF-1 This is in the Adobe Portable Document format (pdf)\nDivision: Consumer ServicesPublished: 2011
Title: Consumer Complaint Form
Please use the complaint form attached when mailing or faxing your insurance issues to the Department.

Form #: GID-CS-CF-1 This is in the Adobe Portable Document format (pdf)\nDivision: Consumer ServicesPublished: 2011
Title: Consumer Complaint Form
Please use the complaint form attached when mailing or faxing your insurance issues to the Department.

5/16/2012 4:41:03 PM
EmploymentE-VerifySitemapTechnical ContactContact UsPrivacy PolicyLaws & Regs
172.16.0.31