DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Therese Ann	DOIID	599113	NAIC NPN	7971796

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	9/22/2006	3/31/2013
Inactive	Non Resident	Agent	Personal Lines	11/29/2004	3/31/2013
Inactive	Non Resident	Agent	Health	9/22/2006	3/31/2013
* 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 Bankers Insurance Company of Florida	300360	Agent - Personal Lines	11/3/2006	3/11/2009
Inactive	Bankers Fidelity Assurance Company	554627	Agent - Health	10/10/2006	3/31/2009
Inactive	Bankers Fidelity Assurance Company	554627	Agent - Life	10/10/2006	3/31/2009
Inactive	Direct General Insurance Company of Mississippi	552453	Agent - Personal Lines	3/1/2005	3/31/2012
Inactive	Direct General Life Insurance Company	301045	Agent - Health	10/10/2006	8/10/2012
Inactive	Direct General Life Insurance Company	301045	Agent - Life	10/10/2006	8/10/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Right Choice Ins Agency Inc	620070	Agent - Personal Lines	5/11/2010	3/31/2013
Inactive	Right Choice Ins Agency Inc	620070	Agent - Life	5/11/2010	8/10/2012
Inactive	Right Choice Ins Agency Inc	620070	Agent - Health	5/11/2010	7/17/2012