DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Mask Jr, Dennis Ray	DOIID	690572	NAIC NPN	1259667

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	10/2/2008	6/30/2016
Inactive	Non Resident	Agent	Health	10/2/2008	6/30/2016
* 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	Berkshire Life Insurance Company of America	300983	Agent - Health	10/8/2008	6/30/2016
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Life	10/8/2008	6/30/2016
Inactive	Guardian Insurance & Annuity Company Inc. (The)	301920	Agent - Life	10/8/2008	6/30/2016
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	10/8/2008	6/30/2016
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	10/8/2008	6/30/2016

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Gallagher Benefit Services Inc	525782	Agent - Life	11/8/2010	6/30/2016
Inactive	Gallagher Benefit Services Inc	525782	Agent - Health	11/8/2010	6/30/2016