DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

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	Health	4/25/2016		9/30/2026
Active	Non Resident	Agent	Life	4/25/2016		9/30/2026
* 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
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