DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Poulsen, Doris Elaine	DOIID	675036	NAIC NPN	10214234

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	2/27/2008	1/31/2016
Inactive	Non Resident	Agent	Health	2/27/2008	1/31/2016
* 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	Mutual of Omaha Insurance Company	301012	Agent - Health	4/5/2012	6/24/2013
Inactive	Transamerica Life Insurance Company	300571	Agent - Health	8/18/2014	1/31/2016
Inactive	United of Omaha Life Insurance Company	300156	Agent - Health	10/2/2013	8/22/2014
Inactive	United of Omaha Life Insurance Company	300156	Agent - Life	10/2/2013	8/22/2014

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Longevity LTC Inc	655557	Agent - Health
Denied	Longevity LTC Inc	655557	Agent - Life