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.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	06/15/2026	08/31/2026

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