DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Faulk, Mary	DOIID	839464	NAIC NPN	2229055

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	4/29/2014	4/22/2016
Inactive	Non Resident	Agent	Health	4/29/2014	4/22/2016
Inactive	Non Resident	Agent	Casualty	4/29/2014	4/22/2016
Inactive	Non Resident	Agent	Property	4/29/2014	4/22/2016
* 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	Bristol West Insurance Company	301655	Agent - Casualty	2/21/2016	4/22/2016
Inactive	Bristol West Insurance Company	301655	Agent - Property	2/21/2016	4/22/2016
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	2/21/2016	4/22/2016
Inactive	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	2/21/2016	4/22/2016
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Casualty	2/21/2016	4/22/2016
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Property	2/21/2016	4/22/2016
Inactive	Foremost Signature Insurance Company	300140	Agent - Casualty	2/21/2016	4/22/2016
Inactive	Foremost Signature Insurance Company	300140	Agent - Property	2/21/2016	4/22/2016
Inactive	Nationwide Life Insurance Company	300495	Agent - Health	7/6/2015	6/6/2016
Inactive	Nationwide Life Insurance Company	300495	Agent - Life	7/6/2015	6/6/2016
Inactive	Nationwide Life and Annuity Insurance Company	300714	Agent - Health	7/6/2015	6/6/2016
Inactive	Nationwide Life and Annuity Insurance Company	300714	Agent - Life	7/6/2015	6/6/2016
Inactive	Nationwide Mutual Insurance Company	301749	Agent - Casualty	5/15/2014	5/9/2016
Inactive	Nationwide Mutual Insurance Company	301749	Agent - Property	5/15/2014	5/9/2016

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 - Health	7/6/2015	4/22/2016
Inactive	Nationwide Sales Solutions Inc	631821	Agent - Life	7/6/2015	4/22/2016
Inactive	Nationwide Sales Solutions Inc	631821	Agent - Property	5/15/2014	4/22/2016
Inactive	Nationwide Sales Solutions Inc	631821	Agent - Casualty	5/15/2014	4/22/2016