DEPARTMENT OF INSURANCE

Name	Fornal, Michael Paul	DOIID	745523	NAIC NPN	7384928

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Variable Life and Variable Annuities	1/5/2011	3/31/2019
Inactive	Non Resident	Agent	Health	1/5/2011	3/31/2019
Inactive	Non Resident	Agent	Life	1/5/2011	3/31/2019

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

Notice: The Department verifies, at the time of application for a Variable Life and Variable Annuity line of authority, that an agent is registered with the Financial Industry Regulatory Authority (FINRA) and the applicant has passed the Series 6 or greater exam. The Department does not verify registration with FINRA after the agent is qualified by the Department to receive the Variable Life and Variable Annuity line of authority. If you have questions about a broker’s FINRA registration status, you should check this status directly with FINRA.

No License Renewal Information

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Residence	Not Public Information
Business / Home Office	160 Gould St Ste 212 Needham Heights, MA 024942300

Phone Information

Type	Phone
Business / Home Office	(617) 229-6242