DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Domitz, David D	DOIID	328259	NAIC NPN	7175273

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Life	7/5/2016	4/1/2022
Inactive	Resident	Agent	Health	12/6/2016	4/1/2022
* 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 Health and Life Insurance Company	300844	Agent - Health	12/6/2016	5/26/2020
Inactive	American Health and Life Insurance Company	300844	Agent - Life	7/5/2016	5/26/2020

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Interstate Agency Inc	610890	Agent - Life	8/10/2018	2/21/2019
Inactive	Interstate Agency Inc	610890	Agent - Health	8/10/2018	2/21/2019
Inactive	Onemain Assurance Services LLC	751094	Agent - Life	6/19/2018	5/26/2020
Inactive	Onemain Assurance Services LLC	751094	Agent - Health	6/19/2018	5/26/2020