DEPARTMENT OF INSURANCE

Affiliations

Name	Fodor, Douglas A	DOIID	713839	NAIC NPN	389253

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Health	9/17/2009	7/1/2011
Inactive	Resident	Agent	Variable Life and Variable Annuities	9/17/2009	7/1/2011
Inactive	Resident	Agent	Life	9/17/2009	7/1/2011
* 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	Equitable Financial Life Insurance Company	300808	Agent - Life	9/23/2009	7/1/2011
Inactive	Equitable Financial Life Insurance Company	300808	Agent - Variable Life and Variable Annuities	9/23/2009	7/1/2011
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Life	6/10/2011	7/1/2011
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Variable Life and Variable Annuities	6/10/2011	7/1/2011
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Health	5/25/2010	7/1/2011
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Life	5/25/2010	7/1/2011
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Variable Life and Variable Annuities	5/25/2010	7/1/2011
Inactive	New York Life Insurance and Annuity Corporation	300726	Agent - Life	4/27/2010	7/1/2011
Inactive	New York Life Insurance and Annuity Corporation	300726	Agent - Variable Life and Variable Annuities	4/27/2010	7/1/2011

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 - Health	5/25/2010	7/1/2011
Inactive	Ubs Financial Services Ins Agency Inc	399373	Agent - Life	5/12/2010	7/1/2011
Inactive	Ubs Financial Services Ins Agency Inc	399373	Agent - Variable Life and Variable Annuities	5/12/2010	7/1/2011