DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Foundation One Insurance Services, Ltd	DOIID	560720	NAIC NPN	7098947

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	12/6/2002	3/31/2018
Inactive	Non Resident	Agent	Health	12/6/2002	3/31/2018
* 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 Fidelity Assurance Company	301004	Agent - Health	12/13/2002	7/10/2014
Inactive	American Fidelity Assurance Company	301004	Agent - Life	12/13/2002	7/10/2014
Inactive	American Public Life Insurance Company	300252	Agent - Health	1/21/2003	1/13/2015
Inactive	American Public Life Insurance Company	300252	Agent - Life	1/21/2003	1/13/2015
Inactive	Connecticut General Life Insurance Company	301333	Agent - Health	10/19/2005	6/11/2014
Inactive	Connecticut General Life Insurance Company	301333	Agent - Life	10/19/2005	6/11/2014
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Health	2/18/2003	8/8/2006
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Life	2/18/2003	8/8/2006
Inactive	Security Mutual Life Insurance Company of NY	300708	Agent - Life	10/27/2004	3/6/2007
Inactive	Stonebridge Life Insurance Company	301614	Agent - Health	9/10/2009	10/1/2015
Inactive	Stonebridge Life Insurance Company	301614	Agent - Life	9/10/2009	10/1/2015
Inactive	Transamerica Life Insurance Company	300571	Agent - Health	1/5/2009	3/31/2018
Inactive	Transamerica Life Insurance Company	300571	Agent - Life	1/5/2009	3/31/2018

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Appleton, Keith Monroe	363950	Agent - Health	12/6/2002	8/13/2014
Inactive	Appleton, Keith Monroe	363950	Agent - Life	12/6/2002	8/13/2014
Inactive	Monroe, Terry L	357844	Agent - Health	2/14/2005	12/31/2007
Inactive	Monroe, Terry L	357844	Agent - Life	2/14/2005	12/31/2007
Inactive	Sims, Stephen Douglas	516798	Agent - Health	3/3/2003	3/31/2018
Inactive	Sims, Stephen Douglas	516798	Agent - Life	3/3/2003	3/31/2018