DEPARTMENT OF INSURANCE
Affiliations
NameBass, Mouzon DOIID741424NAIC NPN1091341
License - Line of Authority Information
StatusResidencyClassLine of AuthorityActive DateInactive DateLicense Expiration Date
ActiveNon ResidentAdministratorNot Applicable2/10/2021 9/30/2025
ActiveNon ResidentAgentLife11/27/2019 9/30/2025
ActiveNon ResidentAgentHealth11/27/2019 9/30/2025
* 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
InactiveArch Insurance Company300688Agent - Health4/18/20126/21/2012
InactiveBerkshire Life Insurance Company of America300983Agent - Health8/12/201110/10/2015
InactiveBerkshire Life Insurance Company of America300983Agent - Life8/12/201110/10/2015
InactiveFidelity Security Life Insurance Company300466Agent - Health1/8/20206/25/2024
InactiveFidelity Security Life Insurance Company300466Agent - Life1/8/20206/25/2024
InactiveGuardian Insurance & Annuity Company Inc. (The)301920Agent - Life8/12/201110/10/2015
InactiveGuardian Life Insurance Company of America301316Agent - Health8/12/201110/10/2015
InactiveGuardian Life Insurance Company of America301316Agent - Life8/12/201110/10/2015
ActiveMutual of Omaha Insurance Company301012Agent - Health1/15/2020 
ActiveUnited World Life Insurance Company300532Agent - Health1/15/2020 
ActiveUnited of Omaha Life Insurance Company300156Agent - Health1/15/2020 
ActiveUnited of Omaha Life Insurance Company300156Agent - Life1/15/2020 
Designated to act on behalf of the following Business Entities
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveEbenconcepts Co955223Agent - Life6/1/20202/16/2024
InactiveEbenconcepts Co955223Agent - Health6/1/20202/16/2024
ActiveEmployers Direct Health Inc744503Administrator - Not Applicable2/12/2021 

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