DEPARTMENT OF INSURANCE

Affiliations

Name	Blond, Samuel David	DOIID	873973	NAIC NPN	17203545

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Health	4/3/2015	3/31/2017
Inactive	Non Resident	Agent	Life	4/3/2015	3/31/2017
* 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	Aetna Health Inc. (PA)	660717	Agent - Health	2/10/2016	4/8/2016
Inactive	Aetna Life Insurance Company	301140	Agent - Health	2/10/2016	4/8/2016
Inactive	Aetna Life Insurance Company	301140	Agent - Life	2/10/2016	4/8/2016
Inactive	Anthem Life Insurance Company	301209	Agent - Health	6/1/2015	3/31/2017
Inactive	Anthem Life Insurance Company	301209	Agent - Life	6/1/2015	3/31/2017
Inactive	Colonial Life and Accident Insurance Company	300846	Agent - Health	9/23/2015	3/31/2017
Inactive	Colonial Life and Accident Insurance Company	300846	Agent - Life	9/23/2015	3/31/2017
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	11/17/2015	12/13/2016
Inactive	Coventry Health and Life Insurance Company	301771	Agent - Health	2/10/2016	4/8/2016
Inactive	Coventry Health and Life Insurance Company	301771	Agent - Life	2/10/2016	4/8/2016
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Health	9/16/2015	4/6/2016
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Life	9/16/2015	4/6/2016
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Health	2/17/2016	4/30/2017
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Life	2/17/2016	4/30/2017
Inactive	Standard Insurance Company	300185	Agent - Health	11/23/2015	3/31/2017
Inactive	Standard Insurance Company	300185	Agent - Life	11/23/2015	3/31/2017
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	2/1/2016	9/14/2016
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	2/1/2016	9/14/2016
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	2/1/2016	9/14/2016
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	2/1/2016	9/14/2016

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 - Life	6/1/2015	3/31/2017
Inactive	Designated Agent Company Inc.	681257	Agent - Health	6/1/2015	3/31/2017