Citizenship Affidavit and Verifiable Identification Document Instructions

Due to the passage of the Illegal Immigration Reform and Enforcement Act of 2011, the Georgia Department of Insurance is required to verify the lawful presence of all new applicants subject to licensure by the Department of Insurance. This includes Agents and Agencies for new submissions. Your license application cannot be processed if this information is not submitted correctly.

Submission Requirements and Process

  1. Print, complete, sign, and notarize The Citizenship Affidavit Form
  2. Make a copy of the FRONT and BACK of one of the secure and verifiable identification documents from the list provided
  3. Submit the form and the copy of the front and back of the acceptable identification document
  4. Submission can be done after completing and paying for your application online via NIPR or Sircon.

Your application cannot be processed for approval until this form and attachments are received.