DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Carrillo, Juan Pablo	DOIID	363173	NAIC NPN	3142507

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	2/8/2019	11/30/2021
Inactive	Non Resident	Agent	Life	2/8/2019	11/30/2021
Denied	Non Resident	Life & Health Consultant	Not Applicable
* 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	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	3/16/2019	5/29/2021
Inactive	Anthem Life Insurance Company	301209	Agent - Health	3/16/2019	5/29/2021
Inactive	Anthem Life Insurance Company	301209	Agent - Life	3/16/2019	5/29/2021
Inactive	Union Fidelity Life Insurance Company	301136	Agent - Health	11/23/1999	9/17/2003
Inactive	Union Fidelity Life Insurance Company	301136	Agent - Life	11/23/1999	9/17/2003
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	1/16/2008	4/11/2008

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Life	3/18/2019	5/29/2021
Inactive	Designated Agent Company Inc.	681257	Agent - Health	3/18/2019	5/29/2021