DEPARTMENT OF INSURANCE

Affiliations

Name	Ambrose, Scott C	DOIID	1173755	NAIC NPN	20151782

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Administrator	Not Applicable	11/22/2021	1/10/2022
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Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Matrix Absence Management Inc	616131	Administrator - Not Applicable	12/2/2021	1/10/2022