DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Banyog Sampsel, Dorette	DOIID	1099516	NAIC NPN	18528528

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Casualty	12/30/2022		2/28/2027
Active	Non Resident	Agent	Life	9/21/2020		2/28/2027
Active	Non Resident	Agent	Health	9/21/2020		2/28/2027
Active	Non Resident	Agent	Property	12/30/2022		2/28/2027
* 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
Inactive	Anthem Health Plans of Kentucky, Inc.	300999	Agent - Health	10/1/2020	5/8/2023
Inactive	Anthem Health Plans of New Hampshire, Inc.	944064	Agent - Health	9/24/2021	5/8/2023
Inactive	Anthem Insurance Companies, Inc.	300941	Agent - Health	9/24/2021	5/8/2023
Inactive	Anthem Life Insurance Company	301209	Agent - Health	10/1/2020	5/8/2023
Inactive	Anthem Life Insurance Company	301209	Agent - Life	10/1/2020	5/8/2023
Inactive	Compcare Health Services Insurance Corporation	948751	Agent - Health	9/16/2021	5/8/2023
Active	Independence American Insurance Company	524747	Agent - Casualty	9/11/2023
Active	Independence American Insurance Company	524747	Agent - Property	9/11/2023
Active	United States Fire Insurance Company	582240	Agent - Casualty	1/10/2023
Active	United States Fire Insurance Company	582240	Agent - Property	1/10/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Active	PTZ Insurance Agency LTD	695420	Agent - Casualty	8/14/2024
Active	PTZ Insurance Agency LTD	695420	Agent - Property	8/14/2024