DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Spencer, Dominique Symone	DOIID	1124610	NAIC NPN	19294055

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	3/15/2021	3/31/2023
Inactive	Non Resident	Agent	Life	3/15/2021	3/31/2023
* 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	Aetna Health Inc. (PA)	660717	Agent - Health	2/3/2022	3/31/2023
Inactive	Aetna Health of Ohio Inc.	1065035	Agent - Health	3/26/2021	3/31/2023
Inactive	Aetna Life Insurance Company	301140	Agent - Health	2/3/2022	3/31/2023
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	3/15/2021	10/12/2021
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	3/15/2021	10/12/2021
Inactive	SilverScript Insurance Company	663526	Agent - Health	3/26/2021	3/31/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Sutherland Global Services Inc	601788	Agent - Life	3/15/2021	10/12/2021
Inactive	Sutherland Global Services Inc	601788	Agent - Health	3/15/2021	3/31/2023