DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Groome, Tate	DOIID	955005	NAIC NPN	7820189

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	5/19/2017		5/31/2025
Active	Non Resident	Agent	Health	5/19/2017		5/31/2025
* 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	Allianz Life Insurance Company of North America	301791	Agent - Life	7/17/2023
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Health	5/22/2017	10/12/2020
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Life	5/22/2017	10/12/2020
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	5/22/2017	10/5/2021
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	5/22/2017	10/5/2021

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Executive Ins Agency Inc	400244	Agent - Life	2/15/2019	10/5/2021
Inactive	Executive Ins Agency Inc	400244	Agent - Health	2/15/2019	10/5/2021