DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Lilien, David Richard	DOIID	802265	NAIC NPN	16858667

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	1/25/2013	3/31/2018
Inactive	Non Resident	Agent	Health	1/25/2013	3/31/2018
* 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	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Health	4/11/2013	11/19/2016
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Life	4/11/2013	11/19/2016
Inactive	LifeSecure Insurance Company	301629	Agent - Health	2/20/2014	3/31/2018
Inactive	Mutual of Omaha Insurance Company	301012	Agent - Health	6/29/2017	4/29/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	L T C I Partners L L C	540090	Agent - Health	4/11/2013	3/31/2018
Inactive	L T C I Partners L L C	540090	Agent - Life	4/11/2013	11/19/2016