DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Champlin, Terri Marie	DOIID	502498	NAIC NPN	7211141

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Denied	Resident	Agent	Health
Inactive	Resident	Agent	Limited Line Credit	8/7/2000	10/31/2024
Inactive	Resident	Agent	Debtors Life	3/6/2000	8/7/2000
Inactive	Resident	Agent	Vehicle Physical Damage	6/15/2000	10/31/2024
Inactive	Resident	Agent	Credit Life & Health	3/6/2000	8/7/2000
Inactive	Resident	Agent	Credit Personal Property & Unemployment	3/6/2000	8/7/2000
Inactive	Resident	Agent	Life	10/24/2017	11/1/2024
* 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	American Health and Life Insurance Company	300844	Agent - Credit Life & Health	3/6/2000	8/7/2000
Inactive	American Health and Life Insurance Company	300844	Agent - Debtors Life	3/6/2000	8/7/2000
Denied	American Health and Life Insurance Company	300844	Agent - Health
Inactive	American Health and Life Insurance Company	300844	Agent - Life	10/24/2017	4/12/2023
Inactive	American Health and Life Insurance Company	300844	Agent - Limited Line Credit	8/7/2000	4/12/2023
Inactive	Merit Life Insurance Co.	300150	Agent - Life	6/20/2018	12/12/2018
Inactive	Merit Life Insurance Co.	300150	Agent - Limited Line Credit	9/14/2016	12/12/2018
Inactive	Triton Insurance Company	300654	Agent - Credit Life & Health		8/7/2000
Inactive	Triton Insurance Company	300654	Agent - Credit Personal Property & Unemployment	3/6/2000	8/7/2000
Inactive	Triton Insurance Company	300654	Agent - Limited Line Credit	8/7/2000	4/12/2023
Inactive	Triton Insurance Company	300654	Agent - Vehicle Physical Damage	6/15/2000	4/12/2023
Inactive	Yosemite Insurance Company	301519	Agent - Limited Line Credit	9/14/2016	1/23/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Interstate Agency Inc	610890	Agent - Limited Line Credit	8/10/2018	2/21/2019
Inactive	Interstate Agency Inc	610890	Agent - Life	8/10/2018	2/21/2019
Inactive	Onemain Assurance Services LLC	751094	Agent - Limited Line Credit	7/26/2018	4/12/2023
Inactive	Onemain Assurance Services LLC	751094	Agent - Life	6/20/2018	4/12/2023