DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Guillaume Jr, Roger Nicholas	DOIID	594863	NAIC NPN	478270

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	9/13/2004	1/27/2006
Inactive	Non Resident	Agent	Health	9/13/2004	1/27/2006
* 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	Venerable Insurance and Annuity Company	301006	Agent - Health	9/13/2004	8/3/2005
Inactive	Venerable Insurance and Annuity Company	301006	Agent - Life	9/13/2004	8/3/2005

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Game Plan Financial Marketing, LLC	595709	Agent - Health	9/17/2004	8/3/2005
Inactive	Game Plan Financial Marketing, LLC	595709	Agent - Life	9/17/2004	8/3/2005