DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Forrest, Michael Benjamin	DOIID	945922	NAIC NPN	18311286

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	2/24/2017	2/29/2020
Inactive	Non Resident	Agent	Health	2/24/2017	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	Colonial Life and Accident Insurance Company	300846	Agent - Health	8/1/2018	7/18/2019
Inactive	Colonial Life and Accident Insurance Company	300846	Agent - Life	8/1/2018	7/18/2019
Inactive	Continental American Insurance Company	301700	Agent - Health	2/20/2019	10/2/2019
Inactive	Continental American Insurance Company	301700	Agent - Life	2/20/2019	10/2/2019
Inactive	Freedom Life Insurance Company of America	300074	Agent - Health	3/3/2017	7/9/2018
Inactive	Freedom Life Insurance Company of America	300074	Agent - Life	3/3/2017	7/9/2018
Inactive	Reserve National Insurance Company	301073	Agent - Health	9/16/2019	1/10/2020
Inactive	Reserve National Insurance Company	301073	Agent - Life	9/16/2019	1/10/2020
Inactive	Southern Guaranty Insurance Company	969411	Agent - Health	10/23/2019	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	Fc Health Group	1040748	Agent - Life	5/16/2019	2/29/2020
Inactive	Fc Health Group	1040748	Agent - Health	5/16/2019	2/29/2020
Inactive	Ushealth Advisors Llc	713288	Agent - Life	3/6/2017	7/9/2018
Inactive	Ushealth Advisors Llc	713288	Agent - Health	3/6/2017	7/9/2018