DEPARTMENT OF INSURANCE
Affiliations
NameBurcham, Derek PayneDOIID641633NAIC NPN8938401
License - Line of Authority Information
StatusResidencyClassLine of AuthorityActive DateInactive DateLicense Expiration Date
InactiveResidentAgentVariable Life and Variable Annuities11/21/20066/1/2013 
InactiveResidentAgentHealth11/21/20066/1/2013 
InactiveResidentAgentLife11/21/20066/1/2013 
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.
Notice: The Department verifies, at the time of application for a Variable Life and Variable Annuity line of authority, that an agent is registered with the Financial Industry Regulatory Authority (FINRA) and the applicant has passed the Series 6 or greater exam. The Department does not verify registration with FINRA after the agent is qualified by the Department to receive the Variable Life and Variable Annuity line of authority. If you have questions about a broker’s FINRA registration status, you should check this status directly with FINRA.

Appointments with the following Insurers
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveAllianz Life Insurance Company of North America301791Agent - Health9/23/20093/3/2011
InactiveAllianz Life Insurance Company of North America301791Agent - Life9/23/20093/3/2011
InactiveAllianz Life Insurance Company of North America301791Agent - Variable Life and Variable Annuities9/23/20093/3/2011
InactiveAmerican General Life Insurance Company301585Agent - Health6/6/20094/25/2011
InactiveAmerican General Life Insurance Company301585Agent - Life6/6/20094/25/2011
InactiveAmerican General Life Insurance Company301585Agent - Variable Life and Variable Annuities6/6/20094/25/2011
InactiveEverlake Life Insurance Company300873Agent - Life8/3/20073/4/2011
InactiveEverlake Life Insurance Company300873Agent - Variable Life and Variable Annuities8/3/20073/4/2011
InactiveFortitude Life Insurance & Annuity Company301503Agent - Health10/13/200911/8/2011
InactiveFortitude Life Insurance & Annuity Company301503Agent - Life10/13/200911/8/2011
InactiveFortitude Life Insurance & Annuity Company301503Agent - Variable Life and Variable Annuities10/13/200911/8/2011
InactiveGeneral American Life Insurance Company300280Agent - Health11/30/20062/23/2007
InactiveGeneral American Life Insurance Company300280Agent - Life11/30/20062/23/2007
InactiveGeneral American Life Insurance Company300280Agent - Variable Life and Variable Annuities11/30/20062/23/2007
InactiveGenworth Life Insurance Company300623Agent - Health10/8/201010/4/2012
InactiveGenworth Life Insurance Company300623Agent - Life10/8/201010/4/2012
InactiveGenworth Life and Annuity Insurance Company301276Agent - Health10/27/200910/4/2012
InactiveGenworth Life and Annuity Insurance Company301276Agent - Life10/27/200912/2/2011
InactiveJackson National Life Insurance Company300486Agent - Life4/12/20076/1/2013
InactiveJackson National Life Insurance Company300486Agent - Variable Life and Variable Annuities4/23/20076/1/2013
InactiveJohn Hancock Life Insurance Company (U.S.A.)300132Agent - Health10/1/20085/18/2011
InactiveJohn Hancock Life Insurance Company (U.S.A.)300132Agent - Life3/24/20095/18/2011
InactiveJohn Hancock Life Insurance Company (U.S.A.)300132Agent - Variable Life and Variable Annuities3/24/20095/18/2011
InactiveLincoln Life Assurance Company of Boston301915Agent - Life6/25/20105/4/2011
InactiveLincoln National Life Insurance Company (The)301382Agent - Health11/21/20062/16/2007
InactiveLincoln National Life Insurance Company (The)301382Agent - Life11/21/20062/16/2007
InactiveLincoln National Life Insurance Company (The)301382Agent - Variable Life and Variable Annuities11/21/20062/16/2007
InactiveMassachusetts Mutual Life Insurance Company300445Agent - Health12/28/200911/12/2012
InactiveMassachusetts Mutual Life Insurance Company300445Agent - Life12/16/200911/12/2012
InactiveMetLife Investors Insurance Company301872Agent - Health11/30/20062/23/2007
InactiveMetLife Investors Insurance Company301872Agent - Life11/30/20062/23/2007
InactiveMetLife Investors Insurance Company301872Agent - Variable Life and Variable Annuities11/30/20062/23/2007
InactiveMetLife Investors USA Insurance Company300845Agent - Health11/30/20062/23/2007
InactiveMetLife Investors USA Insurance Company300845Agent - Life11/30/20062/23/2007
InactiveMetLife Investors USA Insurance Company300845Agent - Variable Life and Variable Annuities11/30/20062/23/2007
InactiveMetropolitan Life Insurance Company301948Agent - Health11/30/20062/23/2007
InactiveMetropolitan Life Insurance Company301948Agent - Life6/16/20103/22/2011
InactiveMetropolitan Life Insurance Company301948Agent - Variable Life and Variable Annuities11/30/20062/23/2007
InactiveNationwide Life Insurance Company300495Agent - Health10/22/20094/5/2011
InactiveNationwide Life Insurance Company300495Agent - Life10/22/20094/5/2011
InactiveNationwide Life Insurance Company300495Agent - Variable Life and Variable Annuities10/22/20094/5/2011
InactiveNationwide Life and Annuity Insurance Company300714Agent - Life11/19/20094/5/2011
InactiveNationwide Life and Annuity Insurance Company300714Agent - Variable Life and Variable Annuities11/19/20094/5/2011
InactiveNew England Life Insurance Company300343Agent - Health11/30/20062/23/2007
InactiveNew England Life Insurance Company300343Agent - Life11/30/20062/23/2007
InactiveNew England Life Insurance Company300343Agent - Variable Life and Variable Annuities11/30/20062/23/2007
InactiveNew York Life Insurance and Annuity Corporation300726Agent - Life2/20/20093/2/2011
InactiveNew York Life Insurance and Annuity Corporation300726Agent - Variable Life and Variable Annuities2/20/20093/2/2011
InactivePacific Life Insurance Company301848Agent - Life4/9/20075/31/2011
InactivePacific Life Insurance Company301848Agent - Variable Life and Variable Annuities4/9/20075/31/2011
InactiveProtective Life Insurance Company300638Agent - Health2/26/20093/1/2011
InactiveProtective Life Insurance Company300638Agent - Life2/26/20093/1/2011
InactiveProtective Life Insurance Company300638Agent - Variable Life and Variable Annuities2/26/20093/1/2011
InactivePruco Life Insurance Company300954Agent - Health2/22/20106/1/2013
InactivePruco Life Insurance Company300954Agent - Life2/22/20106/1/2013
InactivePruco Life Insurance Company300954Agent - Variable Life and Variable Annuities2/22/20106/1/2013
InactiveSunAmerica Annuity and Life Assurance Company301930Agent - Life11/30/200611/21/2011
InactiveSunAmerica Annuity and Life Assurance Company301930Agent - Variable Life and Variable Annuities11/30/200611/21/2011
InactiveTalcott Resolution Life Insurance Company301759Agent - Health4/6/20074/18/2011
InactiveTalcott Resolution Life Insurance Company301759Agent - Life4/6/20074/18/2011
InactiveTalcott Resolution Life Insurance Company301759Agent - Variable Life and Variable Annuities4/6/20074/18/2011
InactiveTalcott Resolution Life and Annuity Insurance Company300932Agent - Health4/6/20074/18/2011
InactiveTalcott Resolution Life and Annuity Insurance Company300932Agent - Life4/6/20074/18/2011
InactiveTalcott Resolution Life and Annuity Insurance Company300932Agent - Variable Life and Variable Annuities4/6/20074/18/2011
InactiveVenerable Insurance and Annuity Company301006Agent - Life6/26/20073/21/2011
InactiveVenerable Insurance and Annuity Company301006Agent - Variable Life and Variable Annuities6/26/20073/21/2011
InactiveWestern National Life Insurance Company300461Agent - Life4/10/20073/3/2011
InactiveWestern and Southern Life Insurance Company301744Agent - Health11/28/20083/2/2011
InactiveWestern and Southern Life Insurance Company301744Agent - Life11/28/20083/2/2011
InactiveWestern-Southern Life Assurance Company301590Agent - Health4/5/20073/2/2011
InactiveWestern-Southern Life Assurance Company301590Agent - Life4/5/20073/2/2011
Designated to act on behalf of the following Business Entities
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveEdward D Jones & Co. Limited Partnership398146Agent - Health12/4/20062/22/2007
InactiveEdward D Jones & Co. Limited Partnership398146Agent - Life12/4/20062/22/2007
InactiveEdward D Jones & Co. Limited Partnership398146Agent - Variable Life and Variable Annuities12/4/20062/22/2007
InactiveFifth Third Insurance Agency Inc399341Agent - Health4/9/20076/1/2013
InactiveFifth Third Insurance Agency Inc399341Agent - Life4/9/20076/1/2013
InactiveFifth Third Insurance Agency Inc399341Agent - Variable Life and Variable Annuities4/9/20076/1/2013

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