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Get GA OCI Form GID-103-AL 2014-2024

Ate? If yes, attach supplement giving full details and attach certified copies of all orders. Have you ever: A. Had any license, permit, authorization, registration, or privilege denied, refused, revoked, suspended, limited, withdrawn, or restricted? B. Had any other disciplinary action taken against you? C. Had the renewal of any license, permit, authorization, registration, or privilege refused by any authority pursuant to a disciplinary proceeding other than that of the Insurance Commissioner.

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