DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Chapman, Blake E	DOIID	748358	NAIC NPN	252806

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	3/2/2011		8/31/2026
Active	Non Resident	Agent	Life	3/2/2011		8/31/2026
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	06/15/2024	08/31/2024	06/06/2024	06/06/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	American Fidelity Assurance Company	301004	Agent - Health	5/10/2020	11/30/2023
Inactive	American Fidelity Assurance Company	301004	Agent - Life	5/10/2020	11/30/2023
Active	Hartford Life and Accident Insurance Company	300878	Agent - Health	11/24/2020
Active	Hartford Life and Accident Insurance Company	300878	Agent - Life	11/24/2020
Inactive	Metropolitan Life Insurance Company	301948	Agent - Health	6/3/2011	12/16/2014
Inactive	Metropolitan Life Insurance Company	301948	Agent - Life	6/3/2011	12/16/2014

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Alliant Insurance Services, Inc.	551378	Agent - Health	5/25/2014	12/16/2014
Inactive	Alliant Insurance Services, Inc.	551378	Agent - Life	5/25/2014	12/16/2014
Denied	Dental Choice Agency Inc.	398085	Agent - Health
Inactive	Willis Of Illinois Inc	398318	Agent - Health	6/7/2011	4/28/2014
Inactive	Willis Of Illinois Inc	398318	Agent - Life	6/7/2011	4/28/2014