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. This required affidavit along with a copy of the secure and verifiable identification from the  list of acceptable identifications is to be provided with your application. This list is also provided with the form as page three. 

Your license application cannot be processed until the completed and notarized affidavit along with a copy of the required identification is submitted correctly.

Submission Requirements and Process

1. Print, complete, sign, and notarize the  Citizenship Affidavit Form
2. Make a copy of the secure and verifiable identification document from the list provided
3. Submit the form and copy of the acceptable identification document
4. Submission can be done after completing and paying for your application online via NIPR or Sircon
5. Attach the form and a copy of the identification document to your application where you applied (NIPR or Sircon). If you need assistance, these instructions can help ( NIPR Warehouse or Sircon portal).

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