DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Forman, Leslie Dean	DOIID	521398	NAIC NPN	667693

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	2/8/2001	1/31/2004
Inactive	Non Resident	Agent	Life	2/8/2001	1/31/2004
* 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	Anthem Life Insurance Company	301209	Agent - Health	2/8/2001	1/31/2004
Inactive	Anthem Life Insurance Company	301209	Agent - Life	2/8/2001	1/31/2004

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Arison Insurance Services, Inc.	401001	Agent - Life	2/23/2001	1/31/2004
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	2/23/2001	1/31/2004