DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Van Dussen, Priscilla Lou	DOIID	503383	NAIC NPN	1948101

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	General Lines	2/29/2000	8/15/2000
Inactive	Non Resident	Agent	Property	8/15/2000	11/30/2013
Inactive	Non Resident	Agent	Casualty	8/15/2000	11/30/2013
* 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	21st Century North America Insurance Company	300884	Agent - Casualty	6/3/2010	3/11/2013
Inactive	21st Century North America Insurance Company	300884	Agent - Property	6/3/2010	3/11/2013
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	8/15/2000	1/9/2014
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - General Lines	2/29/2000	8/15/2000
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	8/15/2000	1/9/2014
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Casualty	2/18/2005	1/9/2014
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Property	2/18/2005	1/9/2014
Inactive	Foremost Signature Insurance Company	300140	Agent - Casualty	2/18/2005	1/9/2014
Inactive	Foremost Signature Insurance Company	300140	Agent - Property	2/18/2005	1/9/2014

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Foremost Express Insurance Agency Inc.	515334	Agent - Property	9/16/2002	11/30/2013
Inactive	Foremost Express Insurance Agency Inc.	515334	Agent - Casualty	9/16/2002	11/30/2013