PUBLIC PROTECTION
CABINET
DEPARTMENT OF INSURANCE
Affiliations
NameBanyog Sampsel, Dorette DOIID1099516NAIC NPN18528528
License - Line of Authority Information
StatusResidencyClassLine of AuthorityActive DateInactive DateLicense Expiration Date
ActiveNon ResidentAgentProperty12/30/2022 2/28/2027
ActiveNon ResidentAgentLife9/21/2020 2/28/2027
ActiveNon ResidentAgentCasualty12/30/2022 2/28/2027
ActiveNon ResidentAgentHealth9/21/2020 2/28/2027
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.
License Renewal Information
ClassInvoice DateResponse Due / Expiration DateResponse Received DatePayment Received DateRenewal Complete
Agent12/15/202602/28/2027   
Appointments with the following Insurers
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveAnthem Health Plans of Kentucky, Inc.300999Agent - Health10/1/20205/8/2023
InactiveAnthem Health Plans of New Hampshire, Inc.944064Agent - Health9/24/20215/8/2023
InactiveAnthem Insurance Companies, Inc.300941Agent - Health9/24/20215/8/2023
InactiveAnthem Life Insurance Company301209Agent - Health10/1/20205/8/2023
InactiveAnthem Life Insurance Company301209Agent - Life10/1/20205/8/2023
InactiveCompcare Health Services Insurance Corporation948751Agent - Health9/16/20215/8/2023
InactiveIndependence American Insurance Company524747Agent - Casualty9/11/20238/7/2025
InactiveIndependence American Insurance Company524747Agent - Property9/11/20238/7/2025
ActiveUnited States Fire Insurance Company582240Agent - Casualty1/10/2023 
ActiveUnited States Fire Insurance Company582240Agent - Property1/10/2023 
Designated to act on behalf of the following Business Entities
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
ActivePTZ Insurance Agency LTD695420Agent - Casualty8/14/2024 
ActivePTZ Insurance Agency LTD695420Agent - Property8/14/2024 

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