Form Gid 391 Al PDF Details

The GID-391-AL form serves as a crucial administrative tool for insurance professionals in Georgia who seek to relocate their practice to another state while ensuring compliance with regulatory requirements. Managed by the Georgia Office of the Commissioner of Insurance, this form facilitates the cancellation of a Georgia insurance license and the issuance of a clearance letter, marking a pivotal step for agents as they navigate through the complexities of state-specific licensing protocols. For a nominal fee, licensees can request a clearance letter, a process that involves the submission of their original Georgia insurance license, an action that symbolizes the termination of their professional identity within the state's borders. The form, detailed in its instructions, also poses a moment of introspection for the licensee, demanding a clear enunciation of their name, addresses, and the precise nature of their request, ultimately culminating in a monetary transaction geared towards finalizing the process. In encapsulating the procedure's administrative, financial, and regulatory dimensions, the GID-391-AL form symbolizes more than a mere paperwork exercise; it represents a significant transition in an insurance professional's career, underscoring the importance of due diligence and procedural adherence within the industry's migratory practices.

QuestionAnswer
Form NameForm Gid 391 Al
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesGID 391 AL Request For Clearance Letter state of georgia insurance commissioner form

Form Preview Example

OFFICE OF COMMISSIONER OF INSURANCE

www.oci.ga.gov

COMMISSIONEROF INSURANCE •INDUSTRIAL LOAN COMMISSIONER•SAFETY FIRE COMMISSIONER

Ralph T. Hudgens, Commissioner

Phone: 855-235-5174E-mail: GAInslicensing@psionline.com

Request For Clearance Letter

AGENTS LICENSING

GID-391-AL AUG2014

1.General Instructions

A.A clearance letter is used by Georgia resident licensees who wish to cancel their Georgia license and apply for a license in a new resident state.

B.The fee for each clearance letter is $10.00.

C.You must submit your Georgia Insurance License with this request. If you have not submitted your license with this request, explain why your license is not included with this request.

I have included my original license card with this request.

I have not included my original license with this request because:

D.Return this request along with payment to: PSI SERVICES LLC / GEORGIA INSURANCE DEPT.

2.Licensee Instructions

Print your complete name as it appears on your Georgia insurance license.

Licensee:

 

Last Name

First Name

 

 

 

MI

Suffix (Jr., Sr.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address (Suite number, floor number, etc…)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

State

 

Zip Code 5-digits

+4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

New Address (Suite number, floor number, etc…)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

State

 

Zip Code 5-digits

+4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Residential Phone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

License Fee and Clearance Letter Request

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

License Number

Social Security Number

 

 

 

National Producer Number

Insert the number of clearance letters requested. Multiply the number of clearance letters requested per license type by the fee of $10.00 per letter. Enter the total in the “Total Amount Enclosed” space.

NOTE: If you hold more than one license, a request for a clearance letter for one license type implies cancellation of all licenses held.

 

Clearance Letter(s) requested for

 

 

 

 

 

 

the following license type(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number Of

 

 

FEE

 

TOTAL AMOUNT

 

 

Clearance Letters Requested

 

(per letter requested)

 

ENCLOSED

 

 

 

 

X

$ 10.00

$

 

 

 

 

 

 

 

 

 

 

WARNING: By requesting a clearance letter, you are canceling your current Georgia license for all license types.

Licensee Signature

Date

MAIL FEES TO:

Bank of America Lockbox Services

Lockbox 742983, 6000 Feldwood Road, College Park, GA 30349

TOTAL OF ALL FEES DUE  $

This office does not discriminate in employment, programs or services. Disabled persons can contact 404-656-2056 to obtain this document in another format.

Page 1 of 1

How to Edit Form Gid 391 Al Online for Free

The whole process of completing the Form Gid 391 Al is actually comparatively effortless. Our team made sure our tool is not hard to use and helps fill in almost any document in no time. Check out several simple steps you have to take:

Step 1: Click the orange button "Get Form Here" on the following website page.

Step 2: Once you have accessed the Form Gid 391 Al editing page you'll be able to notice all of the actions you'll be able to conduct relating to your file within the upper menu.

For every single segment, create the details requested by the application.

completing Form Gid 391 Al stage 1

Complete the License Fee and Clearance Letter, License Number, Social Security Number, National Producer Number, Insert the number of clearance, NOTE If you hold more than one, Clearance Letters requested for, Number Of Clearance Letters, FEE per letter requested, TOTAL AMOUNT ENCLOSED, WARNING By requesting a clearance, Licensee Signature, Date, MAIL FEES TO, and Bank of America Lockbox Services section using the data requested by the system.

Form Gid 391 Al License Fee and Clearance Letter, License Number, Social Security Number, National Producer Number, Insert the number of clearance, NOTE If you hold more than one, Clearance Letters requested for, Number Of Clearance Letters, FEE per letter requested, TOTAL AMOUNT ENCLOSED, WARNING By requesting a clearance, Licensee Signature, Date, MAIL FEES TO, and Bank of America Lockbox Services fields to insert

Step 3: Hit "Done". Now you can transfer the PDF form.

Step 4: To prevent yourself from different issues in the foreseeable future, try to have up to a few copies of the file.

Watch Form Gid 391 Al Video Instruction

Please rate Form Gid 391 Al

1 Votes
If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .