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Get GA PC-FFNS 2006-2024

6/06 NON-SERFF FILING FEE TRANSMITTAL (ONE COMPLETED FORM AND CHECK REQUIRED FOR EACH COMPANY CONFIRMATION NUMBER) Company Name: Confirmation Number: Date of Submission Check Number FORMS FILING FEES: (a) (b) (c) (d) (e) Georgia Filing Number of Georgia Fees Retaliatory Fee Total Fee Forms (a) X (b) (Fee charged by insurer's The Greater of State of ($25 per form, Submitted do.

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