DEPARTMENT OF INSURANCE

Affiliations

Name	Bollenbacher, Robert T	DOIID	374112	NAIC NPN	2204812

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Life	5/11/2004	6/30/2012
Inactive	Non Resident	Agent	Health	4/21/1993	9/30/1999
* 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	Banner Life Insurance Company	301696	Agent - Life	8/25/2009	6/30/2012
Inactive	First Colony Life Insurance Company	301179	Agent - Life	10/19/2005	1/1/2007
Inactive	Genworth Life and Annuity Insurance Company	301276	Agent - Life	1/1/2007	12/9/2008
Inactive	Humana Insurance Company	301104	Agent - Health	12/6/1994	9/30/1999
Inactive	Humana Insurance Company	301104	Agent - Life	12/6/1994	9/30/1999
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	11/7/2007	12/30/2009
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Life	12/30/2009	6/30/2012
Inactive	Nassau Life Insurance Company	301406	Agent - Health	5/17/1999	9/30/1999
Inactive	Nassau Life Insurance Company	301406	Agent - Life	5/17/1999	9/30/1999
Inactive	New York Life Insurance Company	300431	Agent - Health	4/21/1993	5/10/1999
Inactive	New York Life Insurance Company	300431	Agent - Life	4/21/1993	5/10/1999
Inactive	New York Life Insurance and Annuity Corporation	300726	Agent - Health	4/21/1993	3/31/1997
Inactive	New York Life Insurance and Annuity Corporation	300726	Agent - Life	4/21/1993	3/31/1997
Inactive	PHL Variable Insurance Company	300525	Agent - Health	5/17/1999	9/30/1999
Inactive	PHL Variable Insurance Company	300525	Agent - Life	5/17/1999	9/30/1999
Inactive	Paul Revere Life Insurance Company	300971	Agent - Health	8/4/1995	9/30/1999
Inactive	Paul Revere Life Insurance Company	300971	Agent - Life	8/4/1995	9/30/1999
Inactive	Protected Home Mutual Life Insurance Company	301399	Agent - Health	12/31/1998	9/30/1999
Inactive	Protected Home Mutual Life Insurance Company	301399	Agent - Life	12/31/1998	9/30/1999
Inactive	Reassure America Life Insurance Company	301902	Agent - Health	6/5/1996	9/30/1999
Inactive	Reassure America Life Insurance Company	301902	Agent - Life	6/5/1996	9/30/1999
Inactive	Union Security Insurance Company	301844	Agent - Health	2/6/1996	9/30/1999
Inactive	Union Security Insurance Company	301844	Agent - Life	2/6/1996	9/30/1999

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Arison Insurance Services, Inc.	401001	Agent - Life	6/25/1996	9/30/1999
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	6/25/1996	9/30/1999