DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

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.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	06/15/2025	08/31/2025

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