DEPARTMENT OF INSURANCE

Name	Van Brocklin, David E	DOIID	743505	NAIC NPN	460816

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Active	Non Resident	Agent	Life	8/15/2020		5/31/2025
Active	Non Resident	Agent	Health	8/15/2020		5/31/2025

*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	03/15/2025	05/31/2025

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Residence	Not Public Information
Business / Home Office	8325 Royal Palm Blvd Coral Springs, FL 33065

Internet Information

Type	Address
Business Email	pfg1@bellsouth.net

Phone Information

Type	Phone
Business / Home Office	(954) 270-0483