DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Daniel, Mark Forrest	DOIID	303052	NAIC NPN	7157000

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	General Lines	3/21/1983	8/15/2000
Inactive	Resident	Agent	Credit Life & Health	7/20/1993	4/1/1996
Inactive	Resident	Agent	Health	10/24/1978	5/5/2000
Inactive	Resident	Agent	Life	10/24/1978	5/5/2000
* 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 Heritage Life Insurance Company	300272	Agent - Health	7/7/1993	5/5/2000
Inactive	American Heritage Life Insurance Company	300272	Agent - Life	7/7/1993	5/5/2000
Inactive	American States Life Insurance Company	301884	Agent - Health	5/10/1983	3/31/1989
Inactive	American States Life Insurance Company	301884	Agent - Life	5/10/1983	3/31/1989
Inactive	Brighthouse Life Insurance Company	301829	Agent - Health	10/24/1978	12/17/1998
Inactive	Brighthouse Life Insurance Company	301829	Agent - Life	10/24/1978	12/17/1998
Inactive	Celina Mutual Insurance Company (The)	301908	Agent - General Lines	4/28/1989	3/31/1992
Inactive	Franklin Life Insurance Company (The)	300779	Agent - Credit Life & Health	7/20/1993	4/1/1996
Inactive	Hartford Accident and Indemnity Company	301917	Agent - General Lines	3/21/1983	8/15/2000
Inactive	Hartford Casualty Insurance Company	301332	Agent - General Lines	3/21/1983	8/15/2000
Inactive	Hartford Fire Insurance Company	300628	Agent - General Lines	3/21/1983	8/15/2000
Inactive	Hartford Insurance Company of the Midwest	301918	Agent - General Lines	10/22/1986	8/15/2000
Inactive	Hartford Underwriters Insurance Company	301064	Agent - General Lines	9/29/1989	8/15/2000
Inactive	Investors Heritage Life Insurance Company	300363	Agent - Credit Life & Health	12/7/1995	3/8/1996
Inactive	Twin City Fire Insurance Company	300721	Agent - General Lines	3/21/1983	8/15/2000

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Chappelle Insurance Service Inc.	401004	Agent - General Lines	5/1/1986	3/31/1998
Inactive	Mountain Valley Ins Agy Inc.	399465	Agent - General Lines	4/9/1991	8/15/2000