DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Clark, Brent	DOIID	761927	NAIC NPN	16360845

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Health	9/8/2011	3/1/2014
Inactive	Resident	Agent	Life	9/13/2011	3/1/2014
Inactive	Resident	Agent	Limited Line Credit	12/5/2014	2/28/2018
* 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	Colonial Life and Accident Insurance Company	300846	Agent - Health	9/26/2011	3/5/2013
Inactive	Colonial Life and Accident Insurance Company	300846	Agent - Life	10/14/2011	3/5/2013
Inactive	Kentucky Home Life Insurance Company	300477	Agent - Limited Line Credit	12/11/2014	2/28/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	First Citizens Bank Hardin County Inc.	398209	Agent - Limited Line Credit	12/18/2014	8/13/2016