DEPARTMENT OF INSURANCE

Affiliations

Name	Domin, Derek Michael	DOIID	1423307	NAIC NPN	12128264

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Health	9/17/2025	4/30/2028
Active	Non Resident	Agent	Life	9/17/2025	4/30/2028
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Pending	Humana MarketPOINT Inc.	398092	Agent - Life
Pending	Humana MarketPOINT Inc.	398092	Agent - Health