DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Wickersham, Keelan Ray	DOIID	1292671	NAIC NPN	20182901

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Health	8/18/2023		2/28/2026
Active	Non Resident	Agent	Life	8/18/2023		2/28/2026
* 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	12/15/2025	02/28/2026

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	8/29/2023	1/2/2024
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	8/29/2023	1/2/2024
Inactive	Tier One Insurance Company	301056	Agent - Health	8/29/2023	1/2/2024
Inactive	Tier One Insurance Company	301056	Agent - Life	8/29/2023	1/2/2024

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Sutherland Global Services Inc	601788	Agent - Life	8/29/2023	1/2/2024
Inactive	Sutherland Global Services Inc	601788	Agent - Health	8/29/2023	1/2/2024