DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Self, Michele Renee	DOIID	841719	NAIC NPN	16686179

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	5/28/2014	1/31/2021
Inactive	Non Resident	Agent	Life	5/28/2014	1/31/2021
* 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	National Teachers Associates Life Insurance Company	300107	Agent - Health	5/30/2014	7/3/2019
Inactive	National Teachers Associates Life Insurance Company	300107	Agent - Life	5/30/2014	7/3/2019

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Horace Mann General Agency Corporation	898360	Agent - Life	2/26/2016	7/3/2019
Inactive	Horace Mann General Agency Corporation	898360	Agent - Health	2/26/2016	7/3/2019
Inactive	National Teacher Associates of Kentucky Inc.	399320	Agent - Life	6/4/2014	3/31/2016
Inactive	National Teacher Associates of Kentucky Inc.	399320	Agent - Health	6/4/2014	3/31/2016