DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Donna Antoinette	DOIID	534409	NAIC NPN	7218581

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Health	8/14/2001	7/1/2004
Inactive	Resident	Agent	Life	8/14/2001	7/1/2004
* 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 Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	5/28/2002	7/1/2004
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	5/28/2002	7/1/2004
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Health	8/14/2001	12/11/2002
Inactive	Continental Life Insurance Company of Brentwood Tennessee	301526	Agent - Life	8/14/2001	12/11/2002

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Advanced Health Group, LLC	523817	Agent - Life	8/20/2001	2/18/2003
Inactive	Advanced Health Group, LLC	523817	Agent - Health	8/20/2001	2/18/2003