DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Buck, Justin Michael	DOIID	757286	NAIC NPN	8780556

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	6/28/2011	4/30/2013
Inactive	Non Resident	Agent	Life	6/28/2011	4/30/2013
* 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	Anthem Life Insurance Company	301209	Agent - Health	10/8/2011	4/30/2013
Inactive	Anthem Life Insurance Company	301209	Agent - Life	10/8/2011	4/30/2013
Inactive	Family Life Insurance Company	300356	Agent - Health	9/18/2012	12/28/2012
Inactive	First Health Life & Health Insurance Company	301735	Agent - Health	8/15/2012	4/30/2013
Inactive	Gerber Life Insurance Company	300529	Agent - Health	7/30/2012	6/24/2013
Inactive	Gerber Life Insurance Company	300529	Agent - Life	7/30/2012	6/24/2013
Inactive	Humana Health Plan of Ohio Inc.	301565	Agent - Health	10/10/2012	6/7/2013
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	10/10/2012	6/7/2013
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	9/23/2011	4/30/2013
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	9/23/2011	4/30/2013

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Life	10/8/2011	4/30/2013
Inactive	Designated Agent Company Inc.	681257	Agent - Health	10/8/2011	4/30/2013
Inactive	Fundamental Insurance and Retirement Planning	675147	Agent - Life	7/23/2012	4/30/2013
Inactive	Fundamental Insurance and Retirement Planning	675147	Agent - Health	7/23/2012	4/30/2013