DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Domitz, Dustin Dean	DOIID	1171770	NAIC NPN	20137538

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Resident	Agent	Limited Line Credit	11/18/2021		2/28/2026
Active	Resident	Agent	Life	4/27/2023		2/28/2026
Active	Resident	Agent	Health	5/31/2023		2/28/2026
* 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	12/15/2025	02/28/2026

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	American Health and Life Insurance Company	300844	Agent - Health	6/1/2023
Active	American Health and Life Insurance Company	300844	Agent - Life	4/28/2023
Active	American Health and Life Insurance Company	300844	Agent - Limited Line Credit	1/11/2022
Active	Triton Insurance Company	300654	Agent - Limited Line Credit	1/11/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Onemain Assurance Services LLC	751094	Agent - Limited Line Credit	1/11/2022
Active	Onemain Assurance Services LLC	751094	Agent - Health	6/1/2023
Active	Onemain Assurance Services LLC	751094	Agent - Life	4/28/2023