DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Bergantzel, Etta M	DOIID	500059	NAIC NPN	1054446

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	12/27/1999	1/31/2005
Inactive	Non Resident	Agent	Life	12/27/1999	1/31/2005
* 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	Continental Casualty Company	301019	Agent - Health	9/18/2000	11/29/2004
Inactive	First Colony Life Insurance Company	301179	Agent - Health	9/14/2000	7/19/2004
Inactive	First Colony Life Insurance Company	301179	Agent - Life	9/14/2000	7/19/2004
Inactive	Genworth Life Insurance Company	300623	Agent - Health	9/14/2000	1/31/2005
Inactive	Genworth Life Insurance Company	300623	Agent - Life	9/14/2000	1/31/2005
Inactive	Reassure America Life Insurance Company	301902	Agent - Health	12/27/1999	1/2/2003
Inactive	Reassure America Life Insurance Company	301902	Agent - Life	12/27/1999	1/2/2003

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	8/1/2002
Inactive	Financial Insurance Services, Inc.	514710	Agent - Health	10/22/2001	8/1/2002