DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Gollakner, Samantha Marie	DOIID	854006	NAIC NPN	17380387

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	9/29/2014	4/30/2016
Inactive	Non Resident	Agent	Health	9/29/2014	4/30/2016
Active	Non Resident	Independent Adjuster	Property & Casualty	10/14/2024		4/30/2026
* 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	Time Insurance Company	300683	Agent - Health	10/2/2014	6/16/2015
Inactive	Time Insurance Company	300683	Agent - Life	10/2/2014	6/16/2015

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	AFICS, Inc	1122840	Independent Adjuster - Property & Casualty	10/25/2024