DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Ten 250 Corporation	DOIID	877131	NAIC NPN	17197729

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	5/6/2015		3/31/2027
Active	Non Resident	Agent	Life	5/6/2015		3/31/2027
* 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	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	6/8/2023	7/14/2023
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	6/8/2023	7/14/2023
Active	Amica Life Insurance Company	301676	Agent - Life	7/31/2024
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	10/11/2016	4/10/2018
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	10/11/2016	4/10/2018
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	10/11/2016	4/10/2018

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Shah, Vivek Ajay	837433	Agent - Health	5/6/2015
Active	Shah, Vivek Ajay	837433	Agent - Life	5/6/2015