Georgia Code Title 33. Insurance § 33-23-33

(1) The office address of the licensee;

(2) The residence address of the licensee;

(3) The name and address of each insurer that the licensee represents directly or indirectly;

(4) The name and address of each agency of which the licensee is proprietor, partner, officer, director, or employee or which the licensee represents;

(5) Every trade name of such agency; and

(6) The names of all partners and members of any firm or association and the corporate name of any corporation owning or operating such agency as such information changes.