DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Mendell, Jake Austin	DOIID	762034	NAIC NPN	15832322

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	8/26/2011	12/31/2012
Inactive	Non Resident	Agent	Health	8/26/2011	12/31/2012
* 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	Fidelity Life Association, A Legal Reserve Life Insurance Company	300774	Agent - Life	1/5/2012	12/31/2012
Inactive	Golden Rule Insurance Company	301943	Agent - Health	11/17/2011	12/31/2012
Inactive	Golden Rule Insurance Company	301943	Agent - Life	11/17/2011	12/31/2012
Inactive	Time Insurance Company	300683	Agent - Health	9/9/2011	12/20/2011
Inactive	Time Insurance Company	300683	Agent - Life	9/9/2011	12/20/2011

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Zoom Health Inc	758495	Agent - Health	9/26/2011	12/31/2012
Inactive	Zoom Health Inc	758495	Agent - Life	9/26/2011	12/31/2012