DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Staples, Edward Eugene	DOIID	840371	NAIC NPN	16618822

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	10/30/2016	6/12/2018
Inactive	Non Resident	Agent	Life	10/30/2016	6/12/2018
* 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	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	11/6/2014	4/8/2016
Inactive	Anthem Life Insurance Company	301209	Agent - Health	12/22/2016	5/31/2017
Inactive	Anthem Life Insurance Company	301209	Agent - Life	12/22/2016	5/31/2017

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Designated Agent Company Inc.	681257	Agent - Health	12/22/2016	5/31/2017
Inactive	Designated Agent Company Inc.	681257	Agent - Life	12/22/2016	5/31/2017