DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Klass, Dustin	DOIID	815721	NAIC NPN	8444038

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	7/26/2013	4/30/2018
Inactive	Non Resident	Agent	Health	7/26/2013	4/30/2018
* 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	Provident Life and Accident Insurance Company	301525	Agent - Health	11/25/2014	4/30/2018
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	11/25/2014	4/30/2018
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	11/25/2014	4/30/2018
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	11/25/2014	4/30/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	USI Insurance Services National, Inc	509421	Agent - Health	12/4/2014	6/1/2017
Inactive	USI Insurance Services National, Inc	509421	Agent - Life	12/4/2014	6/1/2017