DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Fisher, Jon Gregory	DOIID	572559	NAIC NPN	6903401

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	3/12/2019	8/31/2022
Inactive	Non Resident	Agent	Life	3/12/2019	8/31/2022
* 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	Provident Life and Accident Insurance Company	301525	Agent - Health	7/16/2003	8/31/2006
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	7/16/2003	8/31/2006
Inactive	ReliaStar Life Insurance Company	301712	Agent - Health	7/7/2005	8/31/2006
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	7/7/2005	8/31/2006
Inactive	ReliaStar Life Insurance Company of New York	301018	Agent - Health	7/7/2005	8/31/2006
Inactive	ReliaStar Life Insurance Company of New York	301018	Agent - Life	7/7/2005	8/31/2006
Inactive	Security Financial Life Insurance Company	300208	Agent - Health	7/10/2003	8/31/2006
Inactive	Security Financial Life Insurance Company	300208	Agent - Life	7/10/2003	8/31/2006

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	National Benefits Partner Insurance Agency LLC	549454	Agent - Health	3/8/2004	8/31/2006
Inactive	National Benefits Partner Insurance Agency LLC	549454	Agent - Life	3/8/2004	8/31/2006