DEPARTMENT OF INSURANCE

Affiliations

Name	Ten Bosch, Jonathan Carel	DOIID	1202003	NAIC NPN	19224497

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Life	4/28/2022	4/30/2025
Active	Non Resident	Agent	Health	4/28/2022	4/30/2025
Active	Non Resident	Agent	Variable Life and Variable Annuities	4/28/2022	4/30/2025
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Notice: The Department verifies, at the time of application for a Variable Life and Variable Annuity line of authority, that an agent is registered with the Financial Industry Regulatory Authority (FINRA) and the applicant has passed the Series 6 or greater exam. The Department does not verify registration with FINRA after the agent is qualified by the Department to receive the Variable Life and Variable Annuity line of authority. If you have questions about a broker’s FINRA registration status, you should check this status directly with FINRA.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	02/15/2025	04/30/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date
Active	Fidelity Investments Life Insurance Company	300620	Agent - Life	5/3/2022
Active	Fidelity Investments Life Insurance Company	300620	Agent - Variable Life and Variable Annuities	5/3/2022
Active	New York Life Insurance and Annuity Corporation	300726	Agent - Health	12/5/2023
Active	New York Life Insurance and Annuity Corporation	300726	Agent - Life	12/5/2023
Active	New York Life Insurance and Annuity Corporation	300726	Agent - Variable Life and Variable Annuities	12/5/2023
Active	USAA Life Insurance Company	300734	Agent - Life	8/10/2022
Active	Western-Southern Life Assurance Company	301590	Agent - Life	5/12/2022
Active	Western-Southern Life Assurance Company	301590	Agent - Variable Life and Variable Annuities	5/12/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date
Active	Fidelity Insurance Agency Inc.	400221	Agent - Life	5/4/2022
Denied	Fidelity Insurance Agency Inc.	400221	Agent - Health
Active	Fidelity Insurance Agency Inc.	400221	Agent - Variable Life and Variable Annuities	5/4/2022