In today's blog post we will be discussing one of the most important aspects of music, tone. Specifically we will be looking at what is known as gid 103 al form and how it can help to shape the sound of your instrument. So if you are interested in learning more about this subject, or simply want to improve your overall playing ability, then please keep reading.
In the list, there's some information concerning the gid 103 al form. It may be beneficial to find out its length, the typical time to complete the form, the fields you will have to fill in, and so forth.
Question | Answer |
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Form Name | Gid 103 Al Form |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names |
OFFICE OF COMMISSIONER OF INSURANCE
www.oci.ga.gov
COMMISSIONER OFINSURANCE •INDUSTRIAL LOAN COMMISSIONER•SAFETY FIRE COMMISSIONER
Jim Beck, Commissioner
Phone:
RESIDENT INSURANCE LICENSE APPLICATION
AGENTS LICENSING
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ONLINE APPLICATION SERVICES |
LICENSURE INFORMATION |
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SCHEDULING AN EXAMINATION |
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www.sircon.com/georgia |
www.oci.ga.gov |
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www.pearsonvue.com or |
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LICENSE NUMBER |
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I. |
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LICENSE |
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NEW TEMPORARY LICENSE * |
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TEMPORARY LICENSE RENEWAL* |
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REINSTATEMENT |
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II. TYPE OF LICENSE |
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III. CLASS (ES) OF INSURANCE |
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AGENT |
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LIMITED SUBAGENT ** |
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LIFE, ACCIDENT & SICKNESS |
PROPERTY AND CASUALTY |
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ADJUSTER |
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PUBLIC ADJUSTER |
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ACCIDENT & SICKNESS |
TITLE |
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COUNSELOR |
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SURPLUS LINES BROKER |
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CASUALTY |
TRAVEL ACCIDENT & SICKNESS |
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CROP HAIL ADJUSTER |
WORKERS |
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CREDIT |
TRAVEL TICKET |
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FRATERNAL AGENT |
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COMPENSATION ADJUSTER |
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LIFE |
VARIABLE PRODUCTS |
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LIMITED HEALTH COUNSELOR |
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LTD. |
WORKERS COMPENSATION |
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PERSONAL LINES |
(FOR ADJUSTER) |
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PROPERTY |
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* FOR A |
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1. |
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NAME OF SPONSORING INSURANCE COMPANY |
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NAIC COMPANY CODE |
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TEMPORARY |
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LICENSE: |
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2. |
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NAME OF SUPERVISING AGENT |
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LICENSE NUMBER |
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** FOR A |
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3. |
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LIMITED |
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SUBAGENT |
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NAME OF SPONSORING AGENT |
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LICENSE NUMBER |
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LICENSE: |
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APPLICANT’S INFORMATION:
4.
5.
8.
9.
10.
11.
12.
FULL LEGAL NAME:
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(FIRST) |
(MIDDLE) |
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(LAST) |
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(SUFFIX) |
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SOCIAL SECURITY NUMBER: |
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6. |
DATE OF BIRTH: |
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7. |
SEX: |
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RESIDENCE ADDRESS (PHYSICAL LOCATION): |
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(STREET AND NUMBER REQUIRED) |
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(CITY) |
(STATE) |
(ZIP) |
(COUNTY) |
(HOME TELEPHONE) |
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RESIDENCE MAILING ADDRESS: |
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(IF OTHER THAN 8) |
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(INCLUDE P.O.BOX, STREET, CITY, STATE, ZIP CODE AND COUNTY) |
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BUSINESS ADDRESS (PHYSICAL LOCATION): |
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(BUSINESS NAME) |
(STREET NUMBER, STREET NAME, SUITE NUMBER) |
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(CITY) |
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(STATE) |
(ZIP) |
(COUNTY) |
(BUSINESS TELEPHONE) |
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BUSINESS MAILING ADDRESS: |
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(IF OTHER THAN 10) |
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(INCLUDE BUSINESS NAME, P.O.BOX, STREET, CITY, STATE, ZIP CODE AND COUNTY) |
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FAX NUMBER: |
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EMAIL: |
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MANDATORY QUESTIONNAIRE:
13. |
Does any insurer or general agent claim that you are indebted or had an agency contract canceled for indebtedness? |
YES |
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If yes, attach a letter from the insurer/agent to whom you are indebted giving full details. |
NO |
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14. |
Have you ever been convicted of or are you currently charged with a felony? |
YES |
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If yes, attach certified copies of ALL plea agreements and court orders. |
NO |
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15. |
Have you been convicted of or are you currently charged with the commission of any crime or pled nolo contendere in a criminal proceeding or |
YES |
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have you received first offender treatment or had adjudication of guilt withheld in a criminal proceeding, other than a minor traffic offense? |
NO |
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If yes, attach a supplement giving full details and attach certified copies of plea agreements and all court orders. |
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16. |
Have you ever been refused or had suspended or revoked an insurance license in any state? |
YES |
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If yes, attach supplement giving full details and attach certified copies of all orders. |
NO |
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17. |
Have you ever had any other administrative action instituted against you by the insurance regulatory authority of any state? |
YES |
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If yes, attach supplement giving full details and attach certified copies of all orders. |
NO |
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18. |
Have you ever: |
A. Had any license, permit, authorization, registration, or privilege denied, refused, revoked, suspended, limited, withdrawn, |
YES |
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or restricted? |
NO |
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B. Had any other disciplinary action taken against you? |
YES |
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NO |
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C. Had the renewal of any license, permit, authorization, registration, or privilege refused by any authority pursuant to a |
YES |
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disciplinary proceeding other than that of the Insurance Commissioner. |
NO |
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D. Failed to notify the Insurance Commissioner in writing within sixty days of the occurrence of any event listed above. |
YES |
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NO |
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If yes to any of the above, attach supplement giving full details and attach certified copies of all orders.
This office does not discriminate in employment, programs or services. Disabled persons can contact
Page 1 of 2
www.oci.ga.gov
OFFICE OF COMMISSIONER OF INSURANCE
RESIDENT INSURANCE LICENSE APPLICATION
AGENTS LICENSING
19. |
Have you ever withdrawn an application for any business or professional license granted by any licensing authority? |
YES |
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If yes, attach supplement indicating the type of license, reason for withdrawal and the licensing authority. |
NO |
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20. |
Do you or will you maintain an office as an insurance agent, adjuster, counselor, limited subagent or surplus lines broker in this state? |
YES |
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NO |
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21. |
Have you ever held an insurance license issued by this department? |
YES |
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If yes, list license type, number and last year licensed. ___________________________________________ |
NO |
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22. |
Have you held an insurance license of any type in any other state within the last 5 years? |
YES |
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If yes, attach an original clearance letter from prior state dated within 90 days. |
NO |
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23. |
Have you completed and attached the notarized Citizenship Affidavit Form |
YES |
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If not, you must do so in order for this application to be processed. The form is available at www.oci.ga.gov. |
NO |
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!!!Submit Application” WITH ALL” required documents !!! Check box to confirm that ALL required documents are attached.
APPLICANT’S ATTESTATION:
I HEREBY CERTIFY THAT ALL THE INFORMATION IN THIS ENTIRE APPLICATION, FORM
SIGNATURE OF APPLICANT
DATE
NOTARY |
Sworn to and Subscribed before Me this _______ day of _________________, ________. |
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SEAL |
In the County of __________________________, State of _________________________. |
( Seal ) |
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SIGNATUREREQUIRED |
________________________________________ |
___________________________ |
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(Signature Of Notary Public) |
(My Commission Expires) |
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SPONSOR’S CERTIFICATE:
REQUIRED IF APPLYING FOR A TEMPORARY LICENSE OR LIMITED SUBAGENT LICENSE ONLY
I HAVE READ THE QUESTIONS AND ANSWERS GIVEN BY THIS APPLICANT HEREIN, AND HAVE MADE A DILIGENT INQUIRY AND INVESTIGATION RELATIVE TO THIS APPLICANT’S CHARACTER, IDENTITY, RESIDENCE, EXPERIENCE AND INSTRUCTION. THE FINDINGS OF SAID INQUIRY AND INVESTIGATION ENABLE ME TO CERTIFY AS FOLLOWS: (1) SAID ANSWERS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF; (2) I AM SATISFIED THAT THE APPLICANT IS TRUSTWORTHY AND QUALIFIED TO ACT AS OUR TEMPORARY AGENT OR LIMITED SUBAGENT AND TO HOLD HIMSELF OR HERSELF IN GOOD FAITH TO GENERAL PUBLIC AS SUCH TEMPORARY AGENT OR LIMITED SUBAGENT; (3) WE DESIRE THAT THE APPLICANT BE LICENSED AS INDICATED TO REPRESENT US IN THE STATE OF GEORGIA.
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Name of insurance company if applying for temporary license |
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or sponsoring agent if applying for limited subagent license |
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Name and Title of company official for temporary license or |
Name |
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name of sponsoring agent for limited subagent |
Title |
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Signature of company official for temporary license or |
Signature |
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sponsoring agent for limited subagent license |
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EFFECTIVE |
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INSTRUCTIONS: |
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BOND |
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COUNSELOR, PUBLIC ADUSTER, SURPLUS LINES BROKER, or LIMITED GROUP HEALTH COUNSELOR applications must include the |
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appropriate BOND with this application. |
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CITIZENSHIP AFFIDAVIT |
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Form |
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All New Applicants, excluding active licensees and individuals that apply for reinstatement within 6 months of expiration date, shall |
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FINGERPRINTS |
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be required to submit electronic fingerprints for a criminal background check. The applicant shall bear the cost for electronic |
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fingerprinting. Fingerprinting information can be found on the department’s website. |
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VARIABLE PRODUCTS |
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A current |
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COUNSELOR LICENSE |
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Attach supplement showing evidence of 5 years experience as an agent, subagent or adjuster or in some other phase of the |
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insurance business or sufficient teaching experience or educational qualifications. |
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FEE SCHEDULE: |
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AGENT LICENSE |
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$115 ($100 LICENSE, $15 APPLICATION) THE AGENT LICENSE FEE IS |
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(FOR ONE CLASS/MAJOR LINE OF INSURANCE) |
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BASED ON CLASSES OF INSURANCE AND LICENSES REQUESTED) |
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TEMPORARY LICENSE |
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$ 75 ($50 LICENSE, $15 APPLICATION, $10 CERTIFICATE OF AUTHORITY) |
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LIMITED SUBAGENT LICENSE |
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$120 ($100 LICENSE, $15 APPLICATION, $5 SUBAGENT CERTIFICATE |
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OF AUTHORITY) |
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ADJUSTER, COUNSELOR & LIMITED GROUP HEALTH COUNSELOR LICENSES |
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$115 ($100 LICENSE, $15 APPLICATION) |
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SURPLUS LINES BROKER LICENSE |
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$615 ($600 LICENSE, $15 APPLICATION) |
MAKE CHECKS OR MONEY ORDERS PAYABLE TO PSI Services LLC / GEORGIA INSURANCE DEPT.
Regular Mailing Address With Payments:
PSI Services LLC,
P.O. Box 742983, Atlanta, GA
Overnight Mailing Address With Payments:
Bank of America, ATTN: PSI Services LLC Box 742983,
6000 Feldwood Road, Atlanta, GA 30349
This office does not discriminate in employment, programs or services. Disabled persons can contact
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