DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Bernard, Jaclyn	DOIID	829431	NAIC NPN	17128785

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	12/12/2013	10/11/2016
Inactive	Non Resident	Agent	Life	12/12/2013	10/11/2016
* 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	Humana Insurance Company	301104	Agent - Health	1/12/2016	10/11/2016
Inactive	Humana Insurance Company	301104	Agent - Life	1/12/2016	10/11/2016

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Gravie Agency LLC	825889	Agent - Life	4/26/2016	6/13/2016
Inactive	Gravie Agency LLC	825889	Agent - Health	4/26/2016	6/13/2016