DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Mattis, Mark S	DOIID	523737	NAIC NPN	3373576

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	8/25/2014	6/30/2017
Inactive	Non Resident	Agent	Life	8/25/2014	6/30/2017
* 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	Anthem Life Insurance Company	301209	Agent - Health	10/30/2014	5/15/2017
Inactive	Anthem Life Insurance Company	301209	Agent - Life	10/30/2014	6/23/2015
Inactive	Columbian Life Insurance Company	300810	Agent - Life	3/26/2001	10/30/2003
Inactive	National Guardian Life Insurance Company	300596	Agent - Life	9/22/2003	6/30/2005
Inactive	North Carolina Mutual Life Insurance Company	300378	Agent - Life	5/27/2004	3/31/2005

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Life	10/30/2014	6/23/2015
Inactive	Designated Agent Company Inc.	681257	Agent - Health	10/30/2014	5/15/2017