DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Fong, Marta Teresa	DOIID	986207	NAIC NPN	2531646

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	3/2/2018	2/29/2020
Inactive	Non Resident	Agent	Health	3/2/2018	2/29/2020
Inactive	Non Resident	Agent	Casualty	3/2/2018	2/29/2020
Inactive	Non Resident	Agent	Property	3/2/2018	2/29/2020
* 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	3/9/2018	2/29/2020
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	3/9/2018	2/29/2020
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	3/9/2018	2/29/2020
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	3/9/2018	2/29/2020
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	4/11/2018	4/30/2020
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	4/11/2018	4/30/2020
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	4/11/2018	4/30/2020
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	4/11/2018	4/30/2018
Inactive	Zurich American Insurance Company	301121	Agent - Casualty	3/22/2018	2/29/2020
Inactive	Zurich American Insurance Company	301121	Agent - Property	3/22/2018	2/29/2020

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Willis Of Illinois Inc	398318	Agent - Life	3/29/2018	1/7/2020
Inactive	Willis Of Illinois Inc	398318	Agent - Property	3/29/2018	1/7/2020
Inactive	Willis Of Illinois Inc	398318	Agent - Health	3/29/2018	1/7/2020
Inactive	Willis Of Illinois Inc	398318	Agent - Casualty	3/29/2018	1/7/2020
Inactive	Willis Towers Watson Midwest, Inc.	534348	Agent - Life	2/1/2020	2/29/2020
Inactive	Willis Towers Watson Midwest, Inc.	534348	Agent - Property	2/1/2020	2/29/2020
Inactive	Willis Towers Watson Midwest, Inc.	534348	Agent - Health	2/1/2020	2/29/2020
Inactive	Willis Towers Watson Midwest, Inc.	534348	Agent - Casualty	2/1/2020	2/29/2020