DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Kiersznowski, Michele R	DOIID	760282	NAIC NPN	7415807

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	8/6/2011	11/15/2016
Inactive	Non Resident	Agent	Life	8/6/2011	11/15/2016
Inactive	Non Resident	Agent	Property	8/6/2011	11/15/2016
Inactive	Non Resident	Agent	Casualty	8/6/2011	11/15/2016
Inactive	Non Resident	Agent	Personal Lines	8/6/2011	11/15/2016
* 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	American Zurich Insurance Company	300592	Agent - Casualty	9/2/2011	11/15/2016
Inactive	American Zurich Insurance Company	300592	Agent - Property	9/2/2011	11/15/2016

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Willis Of New Jersey Inc	595076	Agent - Health
Inactive	Willis Of New Jersey Inc	595076	Agent - Casualty	9/2/2011	3/15/2016
Inactive	Willis Of New Jersey Inc	595076	Agent - Property	9/2/2011	3/15/2016
Denied	Willis Of New Jersey Inc	595076	Agent - Life