DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Crockett, Matthew L	DOIID	1277891	NAIC NPN	20701887

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	6/2/2023		8/31/2026
Active	Non Resident	Agent	Life	6/2/2023		8/31/2026
* 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	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	6/15/2023	7/9/2024
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	6/15/2023	7/9/2024
Inactive	CMFG Life Insurance Company	300929	Agent - Life	2/23/2024	8/12/2024
Inactive	Chesapeake Life Insurance Company (The)	301017	Agent - Health	8/13/2024	2/3/2025
Inactive	Chesapeake Life Insurance Company (The)	301017	Agent - Life	8/13/2024	2/3/2025
Inactive	Tier One Insurance Company	301056	Agent - Health	6/16/2023	7/1/2024
Inactive	Tier One Insurance Company	301056	Agent - Life	6/16/2023	7/1/2024

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	6/15/2023	7/4/2024
Inactive	Sutherland Global Services Inc	601788	Agent - Health	6/15/2023	7/4/2024