DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Cislo, Benjamin Douglas	DOIID	696335	NAIC NPN	12567484

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	12/30/2008	4/10/2018
Inactive	Non Resident	Agent	Health	10/5/2009	4/10/2018
Inactive	Non Resident	Agent	Casualty	12/30/2008	4/10/2018
Inactive	Non Resident	Agent	Life	10/5/2009	4/10/2018
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Southwest Business Corporation	552783	Agent - Casualty
Denied	Southwest Business Corporation	552783	Agent - Property
Denied	Southwest Business Corporation	552783	Agent - Health
Denied	Southwest Business Corporation	552783	Agent - Life