DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Ysebaert, Thomas Anthony	DOIID	759240	NAIC NPN	11136805

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	7/26/2011	1/31/2014
Inactive	Non Resident	Agent	Casualty	7/26/2011	1/31/2014
Inactive	Non Resident	Agent	Health	2/5/2013	1/31/2014
* 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	AMEX Assurance Company	301728	Agent - Casualty	2/20/2013	4/2/2013
Inactive	AMEX Assurance Company	301728	Agent - Health	2/20/2013	4/2/2013
Inactive	AMEX Assurance Company	301728	Agent - Property	2/20/2013	4/2/2013
Inactive	American Family Connect Property and Casualty Insurance Company	622403	Agent - Casualty	8/3/2011	11/2/2011
Inactive	American Family Connect Property and Casualty Insurance Company	622403	Agent - Property	8/3/2011	11/2/2011

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Alorica Customer Care, Inc.	800938	Agent - Property	3/5/2013	3/29/2013
Inactive	Alorica Customer Care, Inc.	800938	Agent - Casualty	3/5/2013	3/29/2013
Inactive	Alorica Customer Care, Inc.	800938	Agent - Health	3/5/2013	3/29/2013