DEPARTMENT OF INSURANCE

Affiliations

Name	Haynes, Samantha	DOIID	936194	NAIC NPN	18190288

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Health	12/5/2016	3/14/2018
Inactive	Resident	Agent	Life	3/6/2017	3/14/2018
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Assuredpartners Nl, Llc	762387	Agent - Health