DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Staples, John	DOIID	321200	NAIC NPN	7168351

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Life	11/18/2009	4/1/2012
Inactive	Resident	Agent	Health	11/18/2009	4/1/2012
Inactive	Resident	Temporary Agent	Debit (Temporary Health)	6/6/1996	9/4/1996
Inactive	Resident	Temporary Agent	Ordinary Life (Temporary Life)	6/6/1996	9/4/1996
* 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	Bankers Life and Casualty Company	300701	Agent - Health	8/26/2011	9/22/2011
Inactive	Bankers Life and Casualty Company	300701	Agent - Life	8/26/2011	9/22/2011
Inactive	Colonial Penn Life Insurance Company	300491	Agent - Health	8/26/2011	9/22/2011
Inactive	Colonial Penn Life Insurance Company	300491	Agent - Life	8/26/2011	9/22/2011
Inactive	Humana Insurance Company	301104	Agent - Health	9/20/2011	10/7/2011
Inactive	Humana Insurance Company	301104	Agent - Life	9/20/2011	10/7/2011
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	3/2/2010	9/2/2010
Inactive	State Farm Life Insurance Company	301810	Agent - Life	9/24/2010	8/19/2011
Inactive	State Farm Mutual Automobile Insurance Company	301732	Agent - Health	9/24/2010	8/19/2011
Inactive	Time Insurance Company	300683	Agent - Health	11/1/2010	8/19/2011
Inactive	Transamerica Premier Life Insurance Company	300558	Temporary Agent - Debit (Temporary Health)	6/6/1996	9/4/1996
Inactive	Transamerica Premier Life Insurance Company	300558	Temporary Agent - Ordinary Life (Temporary Life)	6/6/1996	9/4/1996
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	3/2/2010	9/2/2010
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	3/2/2010	9/2/2010
Inactive	Woodmen of the World Life Insurance Society	301446	Agent - Health	11/20/2009	9/1/2010
Inactive	Woodmen of the World Life Insurance Society	301446	Agent - Life	11/20/2009	9/1/2010

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Woodmen Insurance Agency, Inc.	579244	Agent - Health	1/8/2010	9/2/2010
Inactive	Woodmen Insurance Agency, Inc.	579244	Agent - Life	1/8/2010	9/2/2010