DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Henley, Deracey	DOIID	769901	NAIC NPN	16464670

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Personal Lines	11/29/2016		6/30/2026
Inactive	Non Resident	Agent	Life	10/19/2012	6/30/2016
* 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	04/15/2024	06/30/2024	04/24/2024	04/24/2024	Yes

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Nationwide Life Insurance Company	300495	Agent - Life	10/25/2012	6/30/2016
Inactive	Nationwide Life and Annuity Insurance Company	300714	Agent - Life	10/25/2012	6/30/2016
Active	Nationwide Mutual Insurance Company	301749	Agent - Personal Lines	2/23/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Nationwide Sales Solutions Inc	631821	Agent - Personal Lines	2/23/2021
Inactive	Nationwide Sales Solutions Inc	631821	Agent - Life	12/3/2013	6/30/2016