DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Fordahl, Jennifer Diane	DOIID	554416	NAIC NPN	4627820

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	8/26/2002	11/30/2017
Inactive	Non Resident	Agent	Life	8/26/2002	11/30/2017
* 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	Banner Life Insurance Company	301696	Agent - Life	5/22/2006	11/30/2017
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Life	1/1/2004	4/1/2007
Inactive	First Colony Life Insurance Company	301179	Agent - Life	9/26/2002	1/1/2007
Inactive	Genworth Life and Annuity Insurance Company	301276	Agent - Life	1/1/2007	12/4/2007
Inactive	Protective Life Insurance Company	300638	Agent - Life	4/1/2007	12/17/2010

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	CIGI Direct Insurance Services, Inc	510807	Agent - Health	9/17/2002	9/17/2002
Inactive	CIGI Direct Insurance Services, Inc	510807	Agent - Life	9/17/2002	6/15/2017