DEPARTMENT OF INSURANCE

Affiliations

Name	Fasi Ins Services Inc	DOIID	593073	NAIC NPN	8151900

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Health	7/13/2016	7/20/2023
Inactive	Non Resident	Agent	Life	7/26/2004	7/20/2023
* 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 General Life Insurance Company	301585	Agent - Life	3/30/2016	7/20/2023
Inactive	Fidelity & Guaranty Life Insurance Company	301359	Agent - Life	6/21/2021	12/17/2021
Inactive	Genworth Life Insurance Company	300623	Agent - Health	8/5/2005	12/7/2012
Inactive	Genworth Life Insurance Company	300623	Agent - Life	8/5/2005	12/7/2012
Inactive	Jackson National Life Insurance Company	300486	Agent - Life	3/29/2013	7/20/2023
Inactive	John Hancock Life Insurance Company	300821	Agent - Health	2/9/2006	12/30/2009
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	2/9/2006	12/30/2009
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Health	10/21/2008	5/25/2016
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Life	10/21/2008	7/20/2023
Inactive	Lincoln Benefit Life Company	301110	Agent - Health	11/22/2006	7/14/2014
Inactive	Lincoln Benefit Life Company	301110	Agent - Life	11/22/2006	7/14/2014
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Health	12/15/2009	5/25/2016
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Life	12/15/2009	7/20/2023
Inactive	MassMutual Ascend Life Insurance Company	300320	Agent - Life	5/23/2021	7/20/2023
Inactive	Metropolitan Life Insurance Company	301948	Agent - Health	12/20/2006	5/25/2016
Inactive	Metropolitan Life Insurance Company	301948	Agent - Life	12/20/2006	7/20/2023
Inactive	Pacific Life Insurance Company	301848	Agent - Life	9/20/2006	12/8/2022
Inactive	Pan-American Assurance Company	301533	Agent - Health	9/20/2004	5/25/2016
Inactive	Pan-American Assurance Company	301533	Agent - Life	9/20/2004	7/20/2023
Inactive	Pan-American Life Insurance Company	301530	Agent - Health	9/20/2004	5/25/2016
Inactive	Pan-American Life Insurance Company	301530	Agent - Life	9/20/2004	7/20/2023
Inactive	Principal Life Insurance Company	300129	Agent - Health	10/22/2007	5/25/2016
Inactive	Principal Life Insurance Company	300129	Agent - Life	10/22/2007	7/20/2023
Inactive	State Life Insurance Company	301497	Agent - Health	8/12/2012	5/25/2016
Inactive	State Life Insurance Company	301497	Agent - Life	8/12/2012	5/11/2018

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Brockland, Mary Christine	833026	Agent - Health	4/23/2014	5/25/2016
Inactive	Brockland, Mary Christine	833026	Agent - Life	4/8/2014	5/25/2016
Denied	Condra, Shannon Rose	559417	Agent - Health
Inactive	Condra, Shannon Rose	559417	Agent - Life	11/20/2015	5/25/2016
Inactive	Fox, Kevin Jeremy	909035	Agent - Health	5/25/2016	7/20/2023
Inactive	Fox, Kevin Jeremy	909035	Agent - Life	5/25/2016	7/20/2023
Inactive	Holcomb, Robert Steven	588170	Agent - Health	1/20/2005	5/8/2014
Inactive	Holcomb, Robert Steven	588170	Agent - Life	1/20/2005	5/8/2014
Inactive	Locko, Stephen Michael	589004	Agent - Health	7/26/2004	1/20/2005
Inactive	Locko, Stephen Michael	589004	Agent - Life	7/26/2004	1/20/2005