DEPARTMENT OF INSURANCE

Affiliations

Name	Forlenza Sr, Jeffrey	DOIID	366251	NAIC NPN	2083220

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Administrator	Not Applicable	3/19/1999	3/31/2001
Inactive	Resident	Agent	Variable Life and Variable Annuities	5/31/2001	7/1/2002
Inactive	Resident	Agent	Life	6/14/1999	7/1/2002
* 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.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Fortitude Life Insurance & Annuity Company	301503	Agent - Life	8/6/2001	7/1/2002
Inactive	Fortitude Life Insurance & Annuity Company	301503	Agent - Variable Life and Variable Annuities	8/6/2001	7/1/2002
Inactive	Glenbrook Life and Annuity Company	301384	Agent - Life	3/26/2001	7/1/2002
Inactive	Glenbrook Life and Annuity Company	301384	Agent - Variable Life and Variable Annuities	3/26/2001	7/1/2002
Inactive	Lincoln Benefit Life Company	301110	Agent - Life	6/12/2000	12/1/2000
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Life	2/28/2001	1/30/2002
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Variable Life and Variable Annuities	9/25/2001	7/1/2002
Inactive	Nationwide Life Insurance Company	300495	Agent - Life	12/19/2001	7/1/2002
Inactive	Nationwide Life Insurance Company	300495	Agent - Variable Life and Variable Annuities	2/15/2002	7/1/2002
Inactive	Pacific Life Insurance Company	301848	Agent - Life	4/30/2001	7/1/2002
Inactive	Pacific Life Insurance Company	301848	Agent - Variable Life and Variable Annuities	12/11/2001	7/1/2002
Inactive	Talcott Resolution Life Insurance Company	301759	Agent - Life	7/12/1999	12/1/2000
Inactive	Talcott Resolution Life and Annuity Insurance Company	300932	Agent - Life	6/14/1999	12/1/2000
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	3/12/2001	7/1/2002
Inactive	United of Omaha Life Insurance Company	300156	Agent - Variable Life and Variable Annuities	5/1/2001	7/1/2002
Inactive	Western Reserve Life Assurance Company of Ohio	300760	Agent - Life	2/5/2001	7/1/2002
Inactive	Western Reserve Life Assurance Company of Ohio	300760	Agent - Variable Life and Variable Annuities	3/14/2001	7/1/2002

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Forlenza, Jeffrey	366251	Administrator - Not Applicable	3/19/1999	3/31/2001

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Forlenza, Jeffrey	366251	Administrator - Not Applicable	3/19/1999	3/31/2001
Inactive	World Financial Group Insurance Agency, LLC	400520	Agent - Life	12/13/2001	7/1/2002
Inactive	World Financial Group Insurance Agency, LLC	400520	Agent - Variable Life and Variable Annuities	12/13/2001	7/1/2002
Inactive	World Marketing Alliance Inc.	398156	Agent - Life	4/30/2001	12/4/2001
Inactive	World Marketing Alliance Inc.	398156	Agent - Variable Life and Variable Annuities	4/30/2001	12/4/2001