TO: Members of the Georgia Self-Insurers Guaranty Trust Fund

FROM: John P. Reale, Administrator

DATE: December 1, 2010

RE: Automation of Member Information Update Form Pilot Program

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In an effort to streamline our annual reporting requirements, we are in the process of automating our annual submission of the Member Information Update Form that is required from all of our members. We are in the beginning stages of program development whereby members can submit portions of the update form online. However any original documentation, such as certifications and financial statements, would still need to be forwarded to our office.

Provided that we are able to proceed with the next phase of this project, we are seeking volunteers who would like to participate in the pilot program. You will still need to forward the original 2011 update form and supporting documentation to our office.

If you would like to participate, please complete the following form and return it to our office in an envelope.

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