DEPARTMENT OF INSURANCE

Affiliations

Name	Self, Charles E	DOIID	526293	NAIC NPN	3309779

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Property	2/11/2016	11/30/2025
Active	Non Resident	Agent	Life	2/11/2016	11/30/2025
Active	Non Resident	Agent	Health	2/11/2016	11/30/2025
Active	Non Resident	Agent	Casualty	2/11/2016	11/30/2025
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	09/15/2025	11/30/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	All Savers Insurance Company	301940	Agent - Health	12/19/2023
Active	All Savers Insurance Company	301940	Agent - Life	12/19/2023
Inactive	American Economy Insurance Company	300315	Agent - Casualty	11/9/2019	5/27/2022
Inactive	American Economy Insurance Company	300315	Agent - Property	11/9/2019	5/27/2022
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	3/12/2020	7/24/2020
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	3/12/2020	7/24/2020
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	4/9/2018	11/14/2021
Inactive	American Southern Home Insurance Company	626276	Agent - Property	4/9/2018	11/14/2021
Inactive	Anthem Life Insurance Company	301209	Agent - Health	8/24/2010	11/30/2015
Inactive	Anthem Life Insurance Company	301209	Agent - Life	8/24/2010	11/30/2015
Inactive	Bristol West Insurance Company	301655	Agent - Casualty	10/31/2021	12/20/2024
Inactive	Bristol West Insurance Company	301655	Agent - Property	10/31/2021	12/20/2024
Inactive	Colonial Life and Accident Insurance Company	300846	Agent - Health	9/7/2001	4/12/2006
Inactive	Colonial Life and Accident Insurance Company	300846	Agent - Life	9/7/2001	4/12/2006
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	4/14/2011	12/8/2015
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	4/14/2011	12/8/2015
Inactive	Encompass Indemnity Company	546376	Agent - Casualty	5/5/2021	10/3/2024
Inactive	Encompass Indemnity Company	546376	Agent - Property	5/5/2021	10/3/2024
Active	Erie Family Life Insurance Company	301400	Agent - Health	9/15/2023
Active	Erie Family Life Insurance Company	301400	Agent - Life	9/15/2023
Active	Erie Insurance Company	300230	Agent - Casualty	9/15/2023
Active	Erie Insurance Company	300230	Agent - Property	9/15/2023
Active	Erie Insurance Company of New York	789916	Agent - Casualty	2/23/2018
Active	Erie Insurance Company of New York	789916	Agent - Property	2/23/2018
Active	Erie Insurance Exchange	300789	Agent - Casualty	2/23/2018
Active	Erie Insurance Exchange	300789	Agent - Property	2/23/2018
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Casualty	9/12/2018	4/26/2024
Inactive	Farmers Property and Casualty Insurance Company	301237	Agent - Property	9/12/2018	4/26/2024
Active	Flagship City Insurance Company	789965	Agent - Casualty	2/23/2018
Active	Flagship City Insurance Company	789965	Agent - Property	2/23/2018
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Casualty	2/23/2016
Active	Foremost Insurance Company Grand Rapids, Michigan	301027	Agent - Property	2/23/2016
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Casualty	9/21/2017	5/11/2018
Inactive	Foremost Property and Casualty Insurance Company	300871	Agent - Property	9/21/2017	5/11/2018
Inactive	Foremost Signature Insurance Company	300140	Agent - Casualty	9/21/2017	5/11/2018
Inactive	Foremost Signature Insurance Company	300140	Agent - Property	9/21/2017	5/11/2018
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	4/14/2011	12/8/2015
Inactive	Humana Insurance Company	301104	Agent - Health	4/14/2011	12/8/2015
Inactive	Humana Insurance Company	301104	Agent - Life	4/14/2011	12/8/2015
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	4/14/2011	12/8/2015
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	4/14/2011	12/8/2015
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Health	2/2/2007	7/2/2007
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Life	2/2/2007	7/2/2007
Inactive	John Alden Life Insurance Company	300573	Agent - Health	10/2/2012	1/24/2013
Inactive	John Alden Life Insurance Company	300573	Agent - Life	10/2/2012	1/24/2013
Inactive	Kanawha Insurance Company	300127	Agent - Health	4/14/2011	10/22/2015
Inactive	Kanawha Insurance Company	300127	Agent - Life	4/14/2011	10/22/2015
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Health	6/29/2007	11/30/2007
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Life	6/29/2007	11/30/2007
Inactive	Progressive Casualty Insurance Company	300696	Agent - Casualty	4/29/2014	11/30/2015
Inactive	Progressive Casualty Insurance Company	300696	Agent - Property	4/29/2014	11/30/2015
Active	SAFECO Insurance Company of America	300159	Agent - Casualty	4/6/2018
Active	SAFECO Insurance Company of America	300159	Agent - Property	4/6/2018
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Casualty	4/6/2018	5/27/2022
Inactive	SAFECO Insurance Company of Illinois	301350	Agent - Property	4/6/2018	5/27/2022
Active	Selective Insurance Company of the Southeast	300381	Agent - Casualty	3/29/2018
Active	Selective Insurance Company of the Southeast	300381	Agent - Property	3/29/2018
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Health	6/12/2014	11/30/2015
Inactive	Standard Security Life Insurance Company of NY	301487	Agent - Life	6/12/2014	11/30/2015
Inactive	State Automobile Mutual Insurance Company	301824	Agent - Casualty	9/28/2018	12/16/2021
Inactive	State Automobile Mutual Insurance Company	301824	Agent - Property	9/28/2018	12/16/2021
Inactive	Time Insurance Company	300683	Agent - Health	9/27/2012	12/20/2014
Inactive	Time Insurance Company	300683	Agent - Life	9/27/2012	12/20/2014
Inactive	United Casualty Insurance Company of America	301322	Agent - Casualty	7/9/2001	1/2/2004
Inactive	United Casualty Insurance Company of America	301322	Agent - Property	7/9/2001	1/2/2004
Inactive	United Insurance Company of America	300775	Agent - Health	7/9/2001	1/2/2004
Inactive	United Insurance Company of America	300775	Agent - Life	7/9/2001	1/2/2004
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	3/22/2022	12/17/2024
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	3/22/2022	12/17/2024
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	3/22/2022	12/17/2024
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Life	1/1/2021	1/7/2021
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	3/22/2022	12/17/2024
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Life	1/1/2021	1/7/2021

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	8/24/2010	11/30/2015
Inactive	Designated Agent Company Inc.	681257	Agent - Health	8/24/2010	11/30/2015
Active	Self Insurance Services, LLC	792398	Agent - Life	10/9/2020
Active	Self Insurance Services, LLC	792398	Agent - Health	10/9/2020
Active	Self Insurance Services, LLC	792398	Agent - Property	3/3/2016
Active	Self Insurance Services, LLC	792398	Agent - Casualty	3/3/2016