DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Werner, Blaine Patrick	DOIID	334498	NAIC NPN	2636315

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	7/2/2001	12/31/2009
Inactive	Non Resident	Agent	Life	7/2/2001	12/31/2009
* 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	Everlake Life Insurance Company	300873	Agent - Life	1/29/2001	5/23/2001
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Health	6/10/2004	12/31/2009
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Life	6/10/2004	12/31/2009
Inactive	PHL Variable Insurance Company	300525	Agent - Health	7/2/2001	2/1/2006
Inactive	PHL Variable Insurance Company	300525	Agent - Life	7/2/2001	2/13/2004
Inactive	Transamerica Advisors Life Insurance Company	300539	Agent - Health	3/28/2008	11/30/2009
Inactive	Transamerica Advisors Life Insurance Company	300539	Agent - Life	3/28/2008	11/24/2009

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Merrill Lynch Life Agency Inc.	400527	Agent - Life	4/2/2008	12/31/2009
Inactive	Merrill Lynch Life Agency Inc.	400527	Agent - Health	4/2/2008	12/31/2009