PUBLIC PROTECTION
CABINET
DEPARTMENT OF INSURANCE
Affiliations
NameForton, Justin MichaelDOIID696618NAIC NPN5963919
License - Line of Authority Information
StatusResidencyClassLine of AuthorityActive DateInactive DateLicense Expiration Date
InactiveNon ResidentAgentLife1/5/20092/28/2015 
InactiveNon ResidentAgentHealth1/5/20092/28/2015 
* 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
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveAnthem Life Insurance Company301209Agent - Health2/10/20142/28/2015
InactiveAnthem Life Insurance Company301209Agent - Life2/10/20142/28/2015
InactiveBankers Fidelity Life Insurance Company300193Agent - Health2/11/20142/28/2015
InactiveBankers Fidelity Life Insurance Company300193Agent - Life2/11/20142/28/2015
InactiveCompBenefits Dental, Inc.591692Agent - Health7/9/20109/3/2013
InactiveDental Concern Inc. (The)301641Agent - Health3/21/20099/3/2013
InactiveHumana Health Plan, Inc.300142Agent - Health2/9/20099/3/2013
InactiveHumana Insurance Company301104Agent - Health2/9/20099/3/2013
InactiveHumana Insurance Company301104Agent - Life2/9/20099/3/2013
InactiveHumana Insurance Company of Kentucky300826Agent - Health2/9/20099/3/2013
InactiveHumana Insurance Company of Kentucky300826Agent - Life2/9/20099/3/2013
InactiveHumanaDental Insurance Company301457Agent - Health2/9/20092/23/2012
InactiveHumanaDental Insurance Company301457Agent - Life2/9/20092/23/2012
InactiveKanawha Insurance Company300127Agent - Health2/9/20099/3/2013
InactiveKanawha Insurance Company300127Agent - Life2/9/20099/3/2013
Designated to act on behalf of the following Business Entities
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveDesignated Agent Company Inc.681257Agent - Life2/10/20142/28/2015
InactiveDesignated Agent Company Inc.681257Agent - Health2/10/20142/28/2015
InactiveFull Service Ins Inc573607Agent - Life6/19/20092/28/2015
InactiveFull Service Ins Inc573607Agent - Health6/19/20092/28/2015

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