DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Samuels, Ethan Wallack	DOIID	916076	NAIC NPN	17448680

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	3/19/2021	7/31/2023
Inactive	Non Resident	Agent	Life	3/19/2021	7/31/2023
* 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	3/29/2021	7/31/2023
Inactive	Aetna Health of Ohio Inc.	1065035	Agent - Health	3/29/2021	7/31/2023
Inactive	Aetna Life Insurance Company	301140	Agent - Health	3/29/2021	7/31/2023
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	5/20/2021	7/31/2023
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Health	3/23/2021	7/31/2023
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Life	3/25/2021	7/31/2023
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Life	6/1/2016	5/13/2019
Inactive	Guardian Insurance & Annuity Company Inc. (The)	301920	Agent - Health	3/23/2021	7/31/2023
Inactive	Guardian Insurance & Annuity Company Inc. (The)	301920	Agent - Life	3/25/2021	7/31/2023
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	3/23/2021	7/31/2023
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	3/25/2021	7/31/2023
Inactive	SilverScript Insurance Company	663526	Agent - Health	3/29/2021	7/31/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	NFS Insurance Agency LLC	904697	Agent - Life	9/23/2016	5/13/2019