DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Jimenez, Roman	DOIID	332930	NAIC NPN	2131036

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	7/13/1999	1/31/2011
Inactive	Non Resident	Agent	Health	7/13/1999	1/31/2011
* 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	Athene Annuity & Life Assurance Company	301798	Agent - Life	2/7/2008	1/31/2011
Inactive	Chase Insurance Life Company	301287	Agent - Health	7/13/1999	4/1/2007
Inactive	Chase Insurance Life Company	301287	Agent - Life	7/13/1999	4/1/2007
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Life	2/14/2005	4/1/2007
Inactive	Fidelity Life Association, A Legal Reserve Life Insurance Company	300774	Agent - Health	10/30/2000	2/1/2010
Inactive	Fidelity Life Association, A Legal Reserve Life Insurance Company	300774	Agent - Life	10/30/2000	2/1/2010
Inactive	Globe Life and Accident Insurance Company	300639	Agent - Health	7/15/2004	5/22/2006
Inactive	Globe Life and Accident Insurance Company	300639	Agent - Life	7/15/2004	5/22/2006
Inactive	Protective Life Insurance Company	300638	Agent - Health	4/1/2007	12/20/2010
Inactive	Protective Life Insurance Company	300638	Agent - Life	4/1/2007	12/20/2010
Inactive	Pruco Life Insurance Company	300954	Agent - Health	11/8/2007	1/4/2010
Inactive	Pruco Life Insurance Company	300954	Agent - Life	11/8/2007	1/4/2010
Inactive	Revol One Insurance Company	300681	Agent - Health	3/5/2008	2/19/2010
Inactive	Revol One Insurance Company	300681	Agent - Life	3/5/2008	2/19/2010
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	1/28/2002	12/30/2009
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	1/28/2002	12/30/2009

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	America Direct Ins Agency Inc	619155	Agent - Life	1/23/2007	3/31/2010
Inactive	America Direct Ins Agency Inc	619155	Agent - Health	1/23/2007	3/31/2010