DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Fairmont Financial Services Inc	DOIID	1050550	NAIC NPN	1995164

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	8/7/2019	3/1/2021
Inactive	Non Resident	Agent	Health	8/7/2019	3/1/2021
* 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 Health Plans of Kentucky, Inc.	300999	Agent - Health	8/15/2019	3/1/2021
Inactive	Anthem Life Insurance Company	301209	Agent - Health	8/15/2019	3/1/2021
Inactive	Anthem Life Insurance Company	301209	Agent - Life	8/15/2019	3/1/2021

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Kaplan, Chanan	721236	Agent - Health	8/7/2019	12/31/2020
Inactive	Kaplan, Chanan	721236	Agent - Life	8/7/2019	12/31/2020