DEPARTMENT OF INSURANCE

Affiliations

Name	Humphreys, Samuel R	DOIID	710650	NAIC NPN	1572013

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Life	8/5/2009	3/31/2011
Inactive	Non Resident	Agent	Variable Life and Variable Annuities	8/5/2009	3/31/2011
* 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

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Pruco Life Insurance Company	300954	Agent - Life	8/10/2009	3/31/2011
Inactive	Pruco Life Insurance Company	300954	Agent - Variable Life and Variable Annuities	8/10/2009	3/31/2011
Inactive	Venerable Insurance and Annuity Company	301006	Agent - Life	8/10/2009	12/22/2009
Inactive	Venerable Insurance and Annuity Company	301006	Agent - Variable Life and Variable Annuities	8/10/2009	12/22/2009

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Ubs Financial Services Ins Agency Inc	399373	Agent - Life	5/12/2010	3/31/2011
Inactive	Ubs Financial Services Ins Agency Inc	399373	Agent - Variable Life and Variable Annuities	5/12/2010	3/31/2011