Individual Information

DAVID FORREST MILLHEIM

OGDEN, UT 84401-1857

Active

forrest@forrestmillheim.com

12/02/2019

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res Producer/Producer Firm	877418	04/24/2013	Active	12/02/2019	12/31/2025

Qualification Type	Original Issue Date	Status	Effective Date
Health	04/24/2013	Active	11/17/2020
Life	04/24/2013	Active	12/02/2019
Health	09/26/2003	Inactive	05/08/2007
Life	09/26/2003	Inactive	05/08/2007
Var. Annuities/Var. Life	02/21/2006	Inactive	05/08/2007

Company Name	Appointment Type	Status	Active Date
153630
AMERICAN LIFE & SECURITY CORP	Life	Active	02/21/2023
63
Company Name	Appointment Type	Status	Active Date
AMERICAN NATIONAL INSURANCE COMPANY	Life	Active	01/09/2023
239
Company Name	Appointment Type	Status	Active Date
FIDELITY & GUARANTY LIFE INSURANCE COMPANY	Life	Active	02/15/2021
1025
Company Name	Appointment Type	Status	Active Date
FORETHOUGHT LIFE INSURANCE COMPANY	Health	Active	02/22/2024
	Life	Active	02/22/2024
132418
Company Name	Appointment Type	Status	Active Date
GCU	Life	Active	03/07/2023
289
Company Name	Appointment Type	Status	Active Date
MASSMUTUAL ASCEND LIFE INSURANCE COMPANY	Life	Active	06/09/2022
442
Company Name	Appointment Type	Status	Active Date
NATIONAL GUARDIAN LIFE INSURANCE COMPANY	Health	Active	11/19/2020
473
Company Name	Appointment Type	Status	Active Date
NORTH AMERICAN COMPANY FOR LIFE & HEALTH INSURANCE	Life	Active	07/10/2022
512
Company Name	Appointment Type	Status	Active Date
PACIFIC LIFE INSURANCE COMPANY	Health	Active	11/13/2024
	Life	Active	11/13/2024
609
Company Name	Appointment Type	Status	Active Date
STANDARD INSURANCE COMPANY	Health	Active	05/22/2023
	Life	Active	05/22/2023

row(s) 1 - 13 of 13

Organization	Association Type	Type	Beg dte	End dte
LIFETIME WEALTH SOLUTIONS	Designated Resp Lic Prdcr	Agency	12/02/2022	-

1 - 1