DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Wall, Douglas B	DOIID	1102148	NAIC NPN	1147832

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	10/2/2020		7/31/2025
Active	Non Resident	Agent	Life	10/2/2020		7/31/2025
* 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
Active	Continental American Insurance Company	301700	Agent - Health	10/12/2021
Active	Continental American Insurance Company	301700	Agent - Life	10/12/2021
Active	Provident Life and Accident Insurance Company	301525	Agent - Health	10/6/2020
Active	Provident Life and Accident Insurance Company	301525	Agent - Life	10/6/2020
Active	Starmount Life Insurance Company	628031	Agent - Health	10/6/2020
Active	UNUM Life Insurance Company of America	300817	Agent - Health	10/6/2020
Active	UNUM Life Insurance Company of America	300817	Agent - Life	10/6/2020
Active	Unum Insurance Company	301499	Agent - Health	10/6/2020
Active	Unum Insurance Company	301499	Agent - Life	10/6/2020

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Willis Towers Watson Midwest, Inc.	534348	Agent - Life	10/11/2021	12/4/2023
Inactive	Willis Towers Watson Midwest, Inc.	534348	Agent - Health	10/11/2021	12/4/2023
Active	Willis Towers Watson Northeast Inc	537673	Agent - Life	9/30/2024
Active	Willis Towers Watson Northeast Inc	537673	Agent - Health	9/30/2024