DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Burnham, Carly Anne	DOIID	749551	NAIC NPN	8946931

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	3/8/2011	5/31/2014
Inactive	Non Resident	Agent	Life	3/21/2011	5/31/2014
Inactive	Non Resident	Agent	Casualty	3/8/2011	5/31/2014
* 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	Nationwide Life Insurance Company	300495	Agent - Life	3/30/2011	6/13/2014
Inactive	Nationwide Life and Annuity Insurance Company	300714	Agent - Life	3/30/2011	6/13/2014
Inactive	Nationwide Mutual Insurance Company	301749	Agent - Casualty	3/24/2011	5/22/2014
Inactive	Nationwide Mutual Insurance Company	301749	Agent - Property	3/24/2011	5/22/2014

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Nationwide Sales Solutions Inc	631821	Agent - Property	4/1/2011	5/15/2014
Inactive	Nationwide Sales Solutions Inc	631821	Agent - Casualty	4/1/2011	5/15/2014
Inactive	Nationwide Sales Solutions Inc	631821	Agent - Life	4/1/2011	5/15/2014