DEPARTMENT OF INSURANCE

Name	Worksite Ins Services Inc	DOIID	938888	NAIC NPN	17888158

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Inactive	Non Resident	Agent	Life	12/5/2016	3/31/2024
Inactive	Non Resident	Agent	Health	12/5/2016	3/31/2024

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

No License Renewal Information

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date.

Address Information

Type	Address
Business / Home Office	33 High St Mineral Point, WI 535651205

Phone Information

Type	Phone
Business / Home Office	(608) 987-0777