DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Boushall, Forrest	DOIID	638250	NAIC NPN	479643

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	8/18/2006		8/31/2025
Active	Non Resident	Agent	Property	8/18/2006		8/31/2025
Active	Non Resident	Agent	Casualty	8/18/2006		8/31/2025
Active	Non Resident	Agent	Health	8/18/2006		8/31/2025
* 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	Equitable Financial Life Insurance Company	300808	Agent - Health	12/20/2007	12/9/2010
Inactive	Equitable Financial Life Insurance Company	300808	Agent - Life	12/20/2007	12/9/2010
Inactive	Genworth Life Insurance Company	300623	Agent - Health	12/27/2007	12/7/2012
Inactive	Genworth Life Insurance Company	300623	Agent - Life	12/27/2007	12/7/2012
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	1/21/2014	5/2/2016
Inactive	Kanawha Insurance Company	300127	Agent - Health	1/11/2011	12/5/2014
Inactive	Kanawha Insurance Company	300127	Agent - Life	1/11/2011	12/5/2014
Inactive	Metropolitan Life Insurance Company	301948	Agent - Health	2/2/2009	12/14/2012
Inactive	Metropolitan Life Insurance Company	301948	Agent - Life	2/2/2009	12/14/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Mcgriff Insurance Services, LLC	400877	Agent - Health
Denied	Mcgriff Insurance Services, LLC	400877	Agent - Life
Denied	Mcgriff Insurance Services, LLC	400877	Agent - Property
Denied	Mcgriff Insurance Services, LLC	400877	Agent - Casualty
Inactive	USI Insurance Services National, Inc	509421	Agent - Health	1/26/2007	3/2/2007
Inactive	USI Insurance Services National, Inc	509421	Agent - Life	1/26/2007	3/2/2007