DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Self, Sandra Lynn	DOIID	357261	NAIC NPN	7194636

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Adjuster	Independent	4/24/2009	2/7/2010
Inactive	Resident	Independent Adjuster	Property & Casualty	3/1/2016	2/1/2019
Inactive	Resident	Independent Adjuster	Workers' Compensation	3/1/2016	2/1/2019
Inactive	Resident	Staff Adjuster	Workers' Compensation	8/18/2010	1/31/2015
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Esis, Incorporated	398029	Adjuster - Independent	7/20/2005	7/13/2006
Inactive	Willis of Louisville, Inc.	401313	Adjuster - Independent	3/9/1995	11/18/1996