• All applicants for agency licensure must submit a U.S. citizenship affidavit.
• This request for agency license should be submitted by agencies located in the State of Georgia. Out-of-state agencies must follow a different procedure.

• The Citizenship Affidavit must be completed and notarized. A copy of the secure and verifiable document must be attached to the completed and notarized affidavit.
• When applying online, the Citizenship Affidavit and supporting documents, Name Approval letter, if required, should be uploaded to complete your application. Your application cannot be processed without all documents uploaded. 

• Completed, signed, and notarized Citizenship Affidavit (GID-276-EN) along with a copy of the secure and verifiable document from the list provided
• A Name Approval Acceptance Letter is required when any of the following terms appear in the agency name: Assurance, Annuity, Benefit, Discount, Fidelity, Guaranty, Health, Insurance, Indemnity, Life, Medical, Manager, Pharmacy, Reciprocal, Reassurance, Reinsurance, Settlement, Syndicate, Surety, Sharing, and Viatical
• Appropriate information regarding any licensed/unlicensed officers, licensed/unlicensed employees, and company affiliations associated with the agency location
• Agency’s name, license number, and FEIN or SSN
• For each of the agency’s owners, officers, and/or directors who are not licensed in the state of Georgia, their information must be provided when applying
• Form of payment for application fee plus $5 processing fee

You can submit a request for agency license online via NIPR or Sircon. For assistance by mail, please contact us. Applying online is the fastest way to receive an agency license.

• Access NIPR or Sircon
• Continue following the prompts as instructed to submit your information and upload any relevant documents
• Submit payment for application fee

• Once your request for agency license has been successfully submitted, we will review your application
• Online submissions should receive a response within ten (10) days.
• If there is an issue with your application, we will contact you
• Agency licenses must be renewed every two years
• If your request is denied, you will receive a Notice of Denial stating the grounds upon which your application was refused; in this case, you have the option to file a written petition to appeal the decision within twenty (20) days of the issuance of the Notice of Denial