DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Bloomer, Melissa D	DOIID	861225	NAIC NPN	2803205

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	5/27/2020	12/31/2022
Inactive	Non Resident	Agent	Health	5/27/2020	12/31/2022
* 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	Boston Mutual Life Insurance Company	300143	Agent - Health	11/24/2014	1/6/2016
Inactive	Boston Mutual Life Insurance Company	300143	Agent - Life	11/24/2014	1/6/2016
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Health	6/30/2020	12/1/2022
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Life	6/30/2020	12/1/2022

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	The Underwriters Group, Inc	674720	Agent - Health	6/30/2020	6/17/2021
Inactive	The Underwriters Group, Inc	674720	Agent - Life	6/30/2020	6/17/2021