DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Rayburn, David Wertheim	DOIID	523383	NAIC NPN	3948680

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	3/19/2001	2/28/2010
Inactive	Non Resident	Agent	Life	3/19/2001	2/28/2010
* 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	Hartford Life and Accident Insurance Company	300878	Agent - Health	10/7/2004	4/1/2010
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Life	10/7/2004	4/1/2010
Inactive	National Union Fire Insurance Company of Pittsburgh, Pennsylvania	300959	Agent - Health	10/19/2004	2/28/2010
Inactive	Stonebridge Life Insurance Company	301614	Agent - Health	3/19/2001	8/19/2009
Inactive	Stonebridge Life Insurance Company	301614	Agent - Life	3/19/2001	8/19/2009

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	3/19/2001	6/8/2007
Inactive	Financial Insurance Services, Inc.	514710	Agent - Health	3/19/2001	6/8/2007