Non-Admitted Insurance

  • Surplus Lines Brokers

    Form GID-212-PT must be utilized when filing quarterly premium tax affidavits for surplus line brokers. Please do not  file zero (no business receipts for the quarter) affidavits until further notice. Only file an affidavit if there is business receipts or returns to report.

    Please Note: Previous versions of the Surplus Line Broker's Affidavit are not acceptable, will be returned, and may be considered not timely filed.

    Forms

    • Quarterly Premium Tax Affidavit (form #  Download this xls file.GID-212-PT ) – The Surplus Line Broker's Quarterly Premium Tax Affidavit Workbook should be used for multi-state or single state placements. This is an Excel workbook that must be saved to your files before completing. This form requires the broker’s signature witnessed by a Notary Public with a notary seal. Instructions for completing the Excel workbook and filing the affidavit may be found at the first tab within the workbook.

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  • Risk Retention Groups

    Do not file zero affidavits until further notice.  

    Please Note:  if you are not filing a fourth quarter affidavit, Form GID-213-PT must be filed by the fourth quarter due date of January 15th. 

    • Georgia Retaliatory Tax Computation (form #:  Download this xls file.GID-213-PT )
    • Risk Retention Group Quarterly Affidavit (form #:  Download this xls file.GID-215-PT ) – This form may be completed utilizing the Excel workbook provided on the Department's website. The information provided in the workbook is compiled to create each affidavit and is then available for manual filing. You will be required to enable the content (macros) upon opening the workbook.
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  • Direct Procurement

    Form GID-214-PT must be filed for insurance independently procured (i.e., procured without a licensed surplus line broker). Please note due dates are different for Surplus Line Broker filings and Direct Procurement filings (O.C.G.A. §§ 33-5-29 (a) and 33-5-33 (a)).
     

    • Report of Person(s) Procuring Insurance from Unauthorized Insurers Affidavit Workbook (Form #:  Download this xls file.GID-214-PT ) – Report of Person(s) Procuring Insurance from Unauthorized Insurers Affidavit Workbook. Use this form for multi-state and single-state placements. This is an Excel workbook that must be SAVED to your files before completing. This form requires the signature witnessed by a Notary Public with a notary seal. Instructions for completing the workbook and filing the affidavit are found at the first tab within the workbook. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal.
    • Report of Person(s) Procuring Insurance from Unauthorized Insurers (Form #:  Download this xls file.GID-214-PT ) – Report of Person(s) Procuring Insurance from Unauthorized Insurers. This form requires signing to be witnessed by a Notary Public and have them affix their Notary seal. This is an Adobe Interactive Form, so you may fill it out on-line and print it and send it to us.
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