DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Doman, Jacqueline	DOIID	913568	NAIC NPN	8033399

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	4/25/2016		9/30/2024
Active	Non Resident	Agent	Health	4/25/2016		9/30/2024
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	07/15/2024	09/30/2024

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Standard Insurance Company	300185	Agent - Health	4/27/2017
Active	Standard Insurance Company	300185	Agent - Life	4/27/2017

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	Mercer Health & Benefits LLC	607080	Agent - Health	1/15/2019
Active	Mercer Health & Benefits LLC	607080	Agent - Life	1/15/2019