DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Cliburn, David	DOIID	1088239	NAIC NPN	5024370

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	7/6/2020		5/31/2026
Active	Non Resident	Agent	Life	7/6/2020		5/31/2026
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	03/15/2024	05/31/2024	05/07/2024	05/07/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	7/6/2020
Active	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	7/6/2020

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Acrisure Wallstreet Partners, LLC	1020531	Agent - Health	7/21/2020	6/14/2024
Inactive	Acrisure Wallstreet Partners, LLC	1020531	Agent - Life	7/21/2020	6/14/2024