DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Ballard, Kelly Wayne	DOIID	334849	NAIC NPN	1502834

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Property	3/2/1999	2/9/2000
Inactive	Resident	Agent	Health	12/11/2003	6/5/2005
Inactive	Resident	Agent	Life	12/11/2003	6/5/2005
Active	Resident	Independent Adjuster	Property & Casualty	10/6/2015		5/31/2025
* 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
Inactive	American General Life and Accident Insurance Company	301362	Agent - Health	12/11/2003	6/5/2005
Inactive	American General Life and Accident Insurance Company	301362	Agent - Life	12/11/2003	6/5/2005
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Health	10/15/1997	2/9/1998
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Life	10/15/1997	2/9/1998
Inactive	Oakwood Insurance Company	300453	Agent - Property	3/2/1999	2/9/2000
Inactive	Pioneer Life Insurance Company	300110	Agent - Health	12/8/1997	2/9/1998
Inactive	Pioneer Life Insurance Company	300110	Agent - Life	12/8/1997	2/9/1998
Inactive	Southwestern Life Insurance Company	301343	Agent - Health	1/8/1998	2/17/1998
Inactive	Southwestern Life Insurance Company	301343	Agent - Life	1/8/1998	2/17/1998
Inactive	Western National Life Insurance Company	300461	Agent - Life	10/12/1999	2/22/2000

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Custard Insurance Adjusters Inc.	401182	Independent Adjuster - Property & Casualty	3/8/2017	7/25/2022