DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Brock, Debra Marie	DOIID	357868	NAIC NPN	253196

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Personal Lines	1/27/2005	1/31/2012
Inactive	Non Resident	Agent	Life	8/1/1997	1/31/2012
Inactive	Non Resident	Agent	Health	8/1/1997	1/31/2012
* 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 - Health	3/23/2006	7/29/2010
Inactive	Athene Annuity & Life Assurance Company	301798	Agent - Life	3/23/2002	7/29/2010
Inactive	Balboa Life Insurance Company	301327	Agent - Health	3/3/2006	9/8/2006
Inactive	Balboa Life Insurance Company	301327	Agent - Life	3/3/2006	9/8/2006
Inactive	Globe Life and Accident Insurance Company	300639	Agent - Health	3/22/2004	10/11/2004
Inactive	Globe Life and Accident Insurance Company	300639	Agent - Life	3/22/2004	10/11/2004
Inactive	Homesite Insurance Company	301139	Agent - Personal Lines	9/1/2005	1/31/2012
Inactive	Jefferson National Life Insurance Company	300258	Agent - Life	8/19/2005	6/8/2006
Inactive	Liberty Life Insurance Company	301542	Agent - Health	5/30/2003	6/30/2006
Inactive	Liberty Life Insurance Company	301542	Agent - Life	5/30/2003	6/30/2006
Inactive	Revol One Insurance Company	300681	Agent - Health	9/26/2006	4/6/2011
Inactive	Revol One Insurance Company	300681	Agent - Life	9/26/2006	4/6/2011
Inactive	Stillwater Insurance Company	567181	Agent - Personal Lines	12/8/2005	3/1/2011
Inactive	Stonebridge Life Insurance Company	301614	Agent - Health	8/1/1997	12/16/2002
Inactive	Stonebridge Life Insurance Company	301614	Agent - Life	8/1/1997	12/16/2002
Inactive	Western Reserve Life Assurance Company of Ohio	300760	Agent - Health	8/10/2005	4/15/2011
Inactive	Western Reserve Life Assurance Company of Ohio	300760	Agent - Life	8/10/2005	4/15/2011
Inactive	Wilton Reassurance Life Company of New York	300163	Agent - Life	1/17/2005	6/8/2006

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Financial Insurance Services, Inc.	514710	Agent - Life	10/22/2001	12/6/2002
Inactive	Financial Insurance Services, Inc.	514710	Agent - Health	10/22/2001	12/6/2002
Inactive	QBE First Enterprises LLC	610980	Agent - Life	10/16/2006	1/10/2011
Inactive	QBE First Enterprises LLC	610980	Agent - Health	10/16/2006	1/10/2011