DEPARTMENT OF INSURANCE
Affiliations
NameStavisky, Adam GordonDOIID657989NAIC NPN9257830
License - Line of Authority Information
StatusResidencyClassLine of AuthorityActive DateInactive DateLicense Expiration Date
InactiveNon ResidentAgentHealth6/20/20075/2/2018 
InactiveNon ResidentAgentLife6/20/20075/2/2018 
* 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
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveFidelity Investments Life Insurance Company300620Agent - Health11/11/20092/28/2018
InactiveFidelity Investments Life Insurance Company300620Agent - Life11/11/20092/28/2018
Designated to act on behalf of the following Business Entities
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveFidelity Employer Ins Services Inc653192Agent - Life11/11/20092/28/2018
InactiveFidelity Employer Ins Services Inc653192Agent - Health11/11/20092/28/2018
InactiveFidelity Insurance Agency Inc.400221Agent - Life4/8/20112/28/2018
InactiveFidelity Insurance Agency Inc.400221Agent - Health4/8/20112/28/2018

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