DEPARTMENT OF INSURANCE
Affiliations
NameZajac, Donald RichardDOIID303416NAIC NPN519366
License - Line of Authority Information
StatusResidencyClassLine of AuthorityActive DateInactive DateLicense Expiration Date
InactiveNon ResidentAgentHealth4/10/19967/31/2015 
InactiveNon ResidentAgentVariable Life and Variable Annuities9/19/20027/31/2015 
InactiveNon ResidentAgentLife4/10/19967/31/2015 
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.
Notice: The Department verifies, at the time of application for a Variable Life and Variable Annuity line of authority, that an agent is registered with the Financial Industry Regulatory Authority (FINRA) and the applicant has passed the Series 6 or greater exam. The Department does not verify registration with FINRA after the agent is qualified by the Department to receive the Variable Life and Variable Annuity line of authority. If you have questions about a broker’s FINRA registration status, you should check this status directly with FINRA.

Appointments with the following Insurers
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveGenworth Life Insurance Company300623Agent - Health12/3/20024/28/2011
InactiveGenworth Life Insurance Company300623Agent - Life12/3/20024/28/2011
InactiveLincoln National Life Insurance Company (The)301382Agent - Health2/1/20128/23/2012
InactiveLincoln National Life Insurance Company (The)301382Agent - Life2/1/20128/23/2012
InactiveLincoln National Life Insurance Company (The)301382Agent - Variable Life and Variable Annuities2/1/20128/23/2012
InactivePaul Revere Life Insurance Company300971Agent - Health2/1/200112/11/2002
InactivePaul Revere Life Insurance Company300971Agent - Life2/1/200112/11/2002
InactiveProvident Life and Accident Insurance Company301525Agent - Health2/1/200111/10/2004
InactiveProvident Life and Accident Insurance Company301525Agent - Life2/1/200111/10/2004
InactiveRiverSource Life Insurance Company301952Agent - Health9/26/20027/31/2015
InactiveRiverSource Life Insurance Company301952Agent - Life9/26/20027/31/2015
InactiveRiverSource Life Insurance Company301952Agent - Variable Life and Variable Annuities9/26/20027/31/2015
InactiveUNUM Life Insurance Company of America300817Agent - Health2/1/200111/10/2004
InactiveUNUM Life Insurance Company of America300817Agent - Life2/1/200111/10/2004
Designated to act on behalf of the following Business Entities
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveAmeriprise Financial Services, LLC398326Agent - Life4/14/20157/31/2015
InactiveAmeriprise Financial Services, LLC398326Agent - Health4/14/20157/31/2015
InactiveAmeriprise Financial Services, LLC398326Agent - Variable Life and Variable Annuities4/14/20157/31/2015

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