DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Forry, Patricia A	DOIID	765718	NAIC NPN	5710279

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Property	10/4/2011		4/30/2026
Active	Non Resident	Agent	Health	10/4/2011		4/30/2026
Active	Non Resident	Agent	Casualty	10/4/2011		4/30/2026
Active	Non Resident	Agent	Life	10/4/2011		4/30/2026
Active	Non Resident	Surplus Lines Broker	Not Applicable	10/11/2011		4/30/2026
* 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
Active	AIG Property Casualty Company	300621	Agent - Casualty	10/17/2019
Active	AIG Property Casualty Company	300621	Agent - Property	10/17/2019
Active	Allianz Global Risks US Insurance Company	301250	Agent - Casualty	8/7/2019
Active	Allianz Global Risks US Insurance Company	301250	Agent - Property	8/7/2019
Active	American Automobile Insurance Company	300953	Agent - Casualty	8/2/2022
Active	American Automobile Insurance Company	300953	Agent - Property	8/2/2022
Active	Boston Mutual Life Insurance Company	300143	Agent - Health	6/22/2012
Active	Boston Mutual Life Insurance Company	300143	Agent - Life	6/22/2012
Active	Employers Insurance Company of Wausau	301813	Agent - Casualty	7/30/2015
Active	Employers Insurance Company of Wausau	301813	Agent - Property	7/30/2015
Active	Liberty Mutual Fire Insurance Company	301913	Agent - Casualty	7/30/2015
Active	Liberty Mutual Fire Insurance Company	301913	Agent - Property	7/30/2015
Active	Mount Vernon Fire Insurance Company	301397	Agent - Casualty	5/21/2012
Active	Mount Vernon Fire Insurance Company	301397	Agent - Property	5/21/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Willis Of New Jersey Inc	595076	Agent - Property	1/7/2014
Active	Willis Of New Jersey Inc	595076	Agent - Life	1/7/2014
Active	Willis Of New Jersey Inc	595076	Agent - Health	1/7/2014
Active	Willis Of New Jersey Inc	595076	Agent - Casualty	1/7/2014
Active	Willis Of New Jersey Inc	595076	Surplus Lines Broker - Not Applicable	2/14/2012