DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Chapman, Derek D	DOIID	687366	NAIC NPN	10003963

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	8/19/2008	4/8/2016
Inactive	Non Resident	Agent	Health	8/19/2008	4/8/2016
* 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	American General Life Insurance Company	301585	Agent - Health	11/26/2011	4/8/2016
Inactive	American General Life Insurance Company	301585	Agent - Life	11/26/2011	4/8/2016
Inactive	Banner Life Insurance Company	301696	Agent - Life	6/12/2014	4/8/2016
Inactive	Fidelity Life Association, A Legal Reserve Life Insurance Company	300774	Agent - Life	8/6/2013	5/20/2014
Inactive	Pruco Life Insurance Company	300954	Agent - Life	8/8/2012	1/16/2013
Inactive	Revol One Insurance Company	300681	Agent - Health	9/3/2008	12/28/2012
Inactive	Revol One Insurance Company	300681	Agent - Life	9/3/2008	5/31/2012
Inactive	Transamerica Life Insurance Company	300571	Agent - Health	6/11/2014	4/8/2016
Inactive	Transamerica Life Insurance Company	300571	Agent - Life	6/11/2014	4/8/2016

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	12/3/2008	3/1/2012
Inactive	QBE First Enterprises LLC	610980	Agent - Health	12/3/2008	3/1/2012