DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Samples, Bernard M	DOIID	336898	NAIC NPN	546944

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	5/5/1992	10/7/1997
Inactive	Non Resident	Agent	Life	5/5/1992	10/7/1997
* 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	Centennial Life Insurance Company (The)	301561	Agent - Health	4/5/1995	3/31/1997
Inactive	Centennial Life Insurance Company (The)	301561	Agent - Life	4/5/1995	3/31/1997
Inactive	First Colony Life Insurance Company	301179	Agent - Life	12/6/1996	10/7/1997
Inactive	Prudential Insurance Company of America	300784	Agent - Health	5/5/1992	10/7/1997
Inactive	Prudential Insurance Company of America	300784	Agent - Life	5/5/1992	10/7/1997
Inactive	United States Life Insurance Company in the City of New York	301126	Agent - Life	12/17/1996	10/7/1997

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Healthplan Services, Inc.	401230	Agent - Health	8/31/1995	3/31/1997