DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Bazelais, Larry	DOIID	1029297	NAIC NPN	18688728

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	2/18/2019	3/31/2024
Inactive	Non Resident	Agent	Life	2/18/2019	3/31/2024
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	AXIS Insurance Company	301290	Agent - Health	3/11/2019	6/14/2023
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	3/7/2019	4/16/2020
Inactive	American Financial Security Life Insurance Co.	301635	Agent - Health	6/18/2019	3/31/2024
Inactive	Federal Insurance Company	301144	Agent - Health	7/12/2019	10/17/2021
Inactive	Federal Life Insurance Company	300945	Agent - Health	8/18/2023	1/8/2024
Inactive	Southern Guaranty Insurance Company	969411	Agent - Health	10/6/2019	11/15/2023
Inactive	Unified Life Insurance Company	543169	Agent - Health	8/31/2023	12/6/2023
Inactive	Wellfleet Insurance Company	300542	Agent - Health	3/17/2021	3/31/2024

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Health Plan Intermediaries Holdings	786463	Agent - Health	3/7/2019	4/19/2022