DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Wollaston, Mindi L	DOIID	601224	NAIC NPN	8349151

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	1/13/2005	3/5/2014
Inactive	Non Resident	Agent	Health	1/13/2005	3/5/2014
* 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	Jefferson National Life Insurance Company	300258	Agent - Life	5/2/2005	6/8/2006
Inactive	Revol One Insurance Company	300681	Agent - Health	9/18/2006	3/26/2010
Inactive	Revol One Insurance Company	300681	Agent - Life	12/29/2010	6/8/2011
Inactive	Wilton Reassurance Life Company of New York	300163	Agent - Life	1/28/2005	6/8/2006

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	QBE First Enterprises LLC	610980	Agent - Life	2/2/2011	6/8/2011
Inactive	QBE First Enterprises LLC	610980	Agent - Health	10/16/2006	3/26/2010