DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Berglund, Kelley Lee	DOIID	327206	NAIC NPN	7174131

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Life	6/19/2000	7/1/2004
Inactive	Resident	Agent	Health	6/19/2000	7/1/2004
* 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	Empower Annuity Insurance Company of America	300259	Agent - Life	1/29/2003	10/16/2003
Inactive	Nationwide Life and Annuity Insurance Company	300714	Agent - Life	6/23/2003	7/1/2004
Inactive	Security Benefit Life Insurance Company	300583	Agent - Health	7/3/2000	7/1/2004
Inactive	Security Benefit Life Insurance Company	300583	Agent - Life	6/29/2000	7/1/2004
Inactive	Western National Life Insurance Company	300461	Agent - Life	7/3/2000	7/1/2004
Inactive	Western-Southern Life Assurance Company	301590	Agent - Health	6/19/2000	7/1/2004
Inactive	Western-Southern Life Assurance Company	301590	Agent - Life	6/19/2000	7/1/2004

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Fifth Third Insurance Agency Inc	399341	Agent - Life	10/19/2000	7/1/2004
Inactive	Fifth Third Insurance Agency Inc	399341	Agent - Health	10/19/2000	7/1/2004