DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Ballard, Tawni M	DOIID	862382	NAIC NPN	16344807

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	12/2/2014		8/31/2025
Active	Non Resident	Agent	Life	12/2/2014		8/31/2025
* 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	Provident Life and Accident Insurance Company	301525	Agent - Health	1/25/2022
Active	Provident Life and Accident Insurance Company	301525	Agent - Life	1/25/2022
Inactive	ReliaStar Life Insurance Company	301712	Agent - Health	9/3/2015	12/18/2020
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	9/3/2015	12/18/2020
Active	Starmount Life Insurance Company	628031	Agent - Health	1/25/2022
Active	UNUM Life Insurance Company of America	300817	Agent - Health	1/25/2022
Active	UNUM Life Insurance Company of America	300817	Agent - Life	1/25/2022
Active	Unum Insurance Company	301499	Agent - Health	1/25/2022
Active	Unum Insurance Company	301499	Agent - Life	1/25/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Custom Benefit Programs Inc	630774	Agent - Life	2/16/2022
Active	Custom Benefit Programs Inc	630774	Agent - Health	2/16/2022