DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Walczak, Robert Joseph	DOIID	318626	NAIC NPN	303571

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	2/20/1996	7/28/1999
Inactive	Non Resident	Agent	Life	2/20/1996	7/28/1999
* 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	Southland Life Insurance Company	301175	Agent - Health	2/20/1996	7/28/1999
Inactive	Southland Life Insurance Company	301175	Agent - Life	2/20/1996	7/28/1999

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Polaris Agency of KY, Inc. [The]	510236	Agent - Life	7/31/1998	7/28/1999
Inactive	Polaris Agency of KY, Inc. [The]	510236	Agent - Health	7/31/1998	7/28/1999