DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Rosenblatt, Carol S	DOIID	567306	NAIC NPN	3945861

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Administrator	Not Applicable	8/25/2005	8/31/2018
Inactive	Non Resident	Agent	Life	4/4/2003	8/31/2018
Inactive	Non Resident	Agent	Health	4/4/2003	8/31/2018
Inactive	Non Resident	Agent	Casualty	7/22/2005	8/31/2018
Inactive	Non Resident	Agent	Property	7/22/2005	8/31/2018
* 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 Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	12/3/2012	8/11/2017
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	12/3/2012	8/11/2017
Inactive	Banner Life Insurance Company	301696	Agent - Life	5/9/2013	12/6/2016
Inactive	Boston Mutual Life Insurance Company	300143	Agent - Health	4/17/2003	6/14/2018
Inactive	Boston Mutual Life Insurance Company	300143	Agent - Life	4/17/2003	6/14/2018
Inactive	Kanawha Insurance Company	300127	Agent - Health	3/5/2010	4/25/2013
Inactive	Kanawha Insurance Company	300127	Agent - Life	3/5/2010	4/25/2013
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	9/18/2013	3/2/2016
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	9/18/2013	3/2/2016
Inactive	ReliaStar Life Insurance Company	301712	Agent - Health	4/4/2003	8/5/2016
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	4/4/2003	8/5/2016
Inactive	ReliaStar Life Insurance Company of New York	301018	Agent - Health	4/4/2003	6/25/2008
Inactive	ReliaStar Life Insurance Company of New York	301018	Agent - Life	4/4/2003	6/25/2008
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	9/18/2013	3/2/2016
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	9/18/2013	3/2/2016
Inactive	Vantage Risk Assurance Company	301730	Agent - Casualty	8/16/2005	2/4/2010
Inactive	Vantage Risk Assurance Company	301730	Agent - Property	8/16/2005	2/4/2010

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Farmington Administrative Services LLC	564133	Administrator - Not Applicable	8/25/2005	8/31/2018
Inactive	The Farmington Company	534046	Agent - Health	7/7/2003	6/14/2018
Inactive	The Farmington Company	534046	Agent - Life	7/7/2003	6/14/2018
Inactive	The Farmington Company	534046	Agent - Casualty	1/19/2017	8/31/2018
Inactive	The Farmington Company	534046	Agent - Property	1/23/2017	8/31/2018