DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Kubica, Michael	DOIID	758473	NAIC NPN	16298936

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Life	7/22/2011	4/1/2013
Inactive	Resident	Agent	Health	7/22/2011	4/1/2013
* 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	Hartford Life and Accident Insurance Company	300878	Agent - Health	11/23/2011	2/23/2012
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Life	11/23/2011	2/23/2012
Inactive	New York Life Insurance Company	300431	Agent - Health	7/28/2011	8/9/2011
Inactive	New York Life Insurance Company	300431	Agent - Life	7/28/2011	8/9/2011
Inactive	New York Life Insurance and Annuity Corporation	300726	Agent - Health	7/28/2011	8/9/2011
Inactive	New York Life Insurance and Annuity Corporation	300726	Agent - Life	7/28/2011	8/9/2011
Inactive	Pennsylvania Life Insurance Company	301321	Agent - Health	11/16/2011	1/6/2012
Inactive	SilverScript Insurance Company	663526	Agent - Health	11/16/2011	1/6/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Buck Global, LLC	594458	Agent - Health	11/16/2011	1/6/2012
Inactive	Buck Global, LLC	594458	Agent - Life	11/23/2011	1/6/2012