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Office of Commissioner of Insurance and Safety Fire - Georgia


This form after completion will be automatically sent to Pearson VUE for processing to cancel your license with the state of Georgia. if you request to cancel a license that is currently under a consent order, the reason for cancellation will be deemed as a revocation and will prohibit reappling in Georgia for up to five (5) years pursuant to O.C.G.A. 33-23-23(c).

Please verify that the license number entered on the form is correct. There is no fee for filing this form.

If you have any questions, please contact Pearson VUE at 800-274-8969.
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03/05/2024Click to Sign

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