Please complete this form and the Citizenship Affidavit. The Citizenship Affidavit must be submitted along with this form.

The Citizenship Affidavit can be found at [Office of Commissioner of Insurance and Safety Fire - State of Georgia] Citizenship Affidavit (GID-276-EN).

The Citizenship Affidavit is to be uploaded (to NIPR or Sircon) with this form and will not be processed without it..

You cannot submit this form electronically. It must be uploaded to your application in Sircon for States or NIPR.

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Office of Commissioner of Insurance and Safety Fire - State of Georgia

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