DEPARTMENT OF INSURANCE

Affiliations

Name	Mansur, Mark Robert	DOIID	812612	NAIC NPN	16219298

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	License Expiration Date
Active	Non Resident	Agent	Variable Life and Variable Annuities	8/28/2023	2/28/2025
Active	Non Resident	Agent	Life	8/28/2023	2/28/2025
Active	Non Resident	Agent	Health	8/28/2023	2/28/2025
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Notice: The Department verifies, at the time of application for a Variable Life and Variable Annuity line of authority, that an agent is registered with the Financial Industry Regulatory Authority (FINRA) and the applicant has passed the Series 6 or greater exam. The Department does not verify registration with FINRA after the agent is qualified by the Department to receive the Variable Life and Variable Annuity line of authority. If you have questions about a broker’s FINRA registration status, you should check this status directly with FINRA.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	12/15/2024	02/28/2025

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	New York Life Insurance Company	300431	Agent - Life	6/19/2013	2/28/2015
Inactive	New York Life Insurance and Annuity Corporation	300726	Agent - Life	6/19/2013	2/28/2015
Inactive	New York Life Insurance and Annuity Corporation	300726	Agent - Variable Life and Variable Annuities	6/19/2013	2/28/2015
Active	Thrivent Financial for Lutherans	301101	Agent - Health	8/31/2023
Active	Thrivent Financial for Lutherans	301101	Agent - Life	8/31/2023
Active	Thrivent Financial for Lutherans	301101	Agent - Variable Life and Variable Annuities	8/31/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	NYLIFE Securities, LLC	645470	Agent - Variable Life and Variable Annuities	6/21/2013	4/2/2015
Inactive	NYLIFE Securities, LLC	645470	Agent - Life	6/21/2013	4/2/2015
Inactive	Thrivent Ins Agency Inc	510973	Agent - Variable Life and Variable Annuities	9/25/2023	9/25/2023
Inactive	Thrivent Ins Agency Inc	510973	Agent - Life	9/25/2023	9/25/2023
Inactive	Thrivent Ins Agency Inc	510973	Agent - Health	9/25/2023	9/25/2023