DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Domagala, Derek Wyatt	DOIID	505313	NAIC NPN	3377488

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	4/13/2000	5/31/2004
Inactive	Non Resident	Agent	Life	4/13/2000	5/31/2004
* 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 Bankers Life Assurance Company of Florida	300171	Agent - Health	4/13/2000	8/7/2002
Inactive	American Bankers Life Assurance Company of Florida	300171	Agent - Life	4/13/2000	8/7/2002
Inactive	Continental Casualty Company	301019	Agent - Health	8/20/2001	4/15/2002
Inactive	Liberty Life Insurance Company	301542	Agent - Health	11/13/2000	1/24/2003
Inactive	Liberty Life Insurance Company	301542	Agent - Life	11/13/2000	1/24/2003
Inactive	Union Security Insurance Company	301844	Agent - Health	2/27/2001	5/31/2004
Inactive	Union Security Insurance Company	301844	Agent - Life	2/27/2001	10/31/2002
Inactive	Wilcac Life Insurance Company	301573	Agent - Health	8/20/2001	4/15/2002
Inactive	Wilcac Life Insurance Company	301573	Agent - Life	8/20/2001	4/15/2002

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	TeleSpectrum, Inc	512199	Agent - Life	7/31/2000	6/10/2002
Inactive	TeleSpectrum, Inc	512199	Agent - Health	7/31/2000	6/10/2002