DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Bautista, Ivan	DOIID	1001297	NAIC NPN	18841664

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	7/17/2018	12/16/2020
Inactive	Non Resident	Agent	Life	7/17/2018	12/16/2020
* 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	Ameritas Life Insurance Corporation	300126	Agent - Health	7/19/2018	1/4/2021
Inactive	Ameritas Life Insurance Corporation	300126	Agent - Life	7/19/2018	1/4/2021
Inactive	Banner Life Insurance Company	301696	Agent - Life	3/5/2019	12/16/2020
Inactive	Gerber Life Insurance Company	300529	Agent - Health	10/20/2020	12/7/2020
Inactive	Gerber Life Insurance Company	300529	Agent - Life	10/20/2020	12/7/2020
Inactive	Great Southern Life Insurance Company	301443	Agent - Health	10/31/2019	9/3/2020
Inactive	Great Southern Life Insurance Company	301443	Agent - Life	10/31/2019	9/3/2020
Inactive	Pruco Life Insurance Company	300954	Agent - Life	8/30/2018	8/19/2020
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	3/14/2020	12/16/2020
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	3/14/2020	12/16/2020

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Health Iq Insurance Services, Inc	882220	Agent - Life	7/19/2018	5/5/2020
Inactive	Health Iq Insurance Services, Inc	882220	Agent - Health	7/19/2018	5/5/2020