DEPARTMENT OF INSURANCE

Affiliations

Name	Waltz, David Alan	DOIID	546035	NAIC NPN	1342397

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Life	5/29/2002	4/30/2005
Inactive	Non Resident	Agent	Variable Life and Variable Annuities	9/29/2005	4/30/2011
Inactive	Non Resident	Agent	Health	5/29/2002	4/30/2005
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Notice: The Department verifies, at the time of application for a Variable Life and Variable Annuity line of authority, that an agent is registered with the Financial Industry Regulatory Authority (FINRA) and the applicant has passed the Series 6 or greater exam. The Department does not verify registration with FINRA after the agent is qualified by the Department to receive the Variable Life and Variable Annuity line of authority. If you have questions about a broker’s FINRA registration status, you should check this status directly with FINRA.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Fortitude Life Insurance & Annuity Company	301503	Agent - Life	9/1/2004	4/30/2005
Inactive	Fortitude Life Insurance & Annuity Company	301503	Agent - Variable Life and Variable Annuities	9/1/2004	4/30/2005
Inactive	Nationwide Life Insurance Company	300495	Agent - Health	5/29/2002	4/30/2005
Inactive	Nationwide Life Insurance Company	300495	Agent - Life	5/29/2002	4/30/2005
Inactive	Nationwide Life Insurance Company	300495	Agent - Variable Life and Variable Annuities	5/29/2002	4/30/2005

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Securities America Inc.	400225	Agent - Variable Life and Variable Annuities	6/28/2002	4/30/2005