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	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.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	02/15/2026	04/30/2026
Surplus Lines Broker	02/15/2026	04/30/2026

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active 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	First Liberty Insurance Corporation (The)	301060	Agent - Casualty	10/1/2024
Active	First Liberty Insurance Corporation (The)	301060	Agent - Property	10/1/2024
Active	LM Insurance Corporation	301061	Agent - Casualty	10/1/2024
Active	LM Insurance Corporation	301061	Agent - Property	10/1/2024
Active	Liberty Insurance Corporation	300444	Agent - Casualty	10/1/2024
Active	Liberty Insurance Corporation	300444	Agent - Property	10/1/2024
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
Inactive	Willis Of New Jersey Inc	595076	Agent - Property	1/7/2014	1/1/2025
Inactive	Willis Of New Jersey Inc	595076	Agent - Life	1/7/2014	1/1/2025
Inactive	Willis Of New Jersey Inc	595076	Agent - Health	1/7/2014	1/1/2025
Inactive	Willis Of New Jersey Inc	595076	Agent - Casualty	1/7/2014	1/1/2025
Active	Willis Of New Jersey Inc	595076	Surplus Lines Broker - Not Applicable	2/14/2012
Active	Willis Towers Watson Northeast Inc	537673	Agent - Property	2/8/2025
Active	Willis Towers Watson Northeast Inc	537673	Agent - Life	2/8/2025
Active	Willis Towers Watson Northeast Inc	537673	Agent - Health	2/8/2025
Active	Willis Towers Watson Northeast Inc	537673	Agent - Casualty	2/8/2025
Active	Willis Towers Watson Northeast Inc	537673	Surplus Lines Broker - Not Applicable	2/8/2025