DEPARTMENT OF INSURANCE

Name	Sample, Mandy	DOIID	898574	NAIC NPN	17774363

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Active	Resident	Agent	Life	11/19/2015		4/30/2027
Active	Resident	Agent	Health	11/19/2015		4/30/2027

*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	02/15/2025	04/30/2025	03/13/2025	03/13/2025	Yes

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
Business / Home Office	17103 Meander Way Louisville, KY 40245
Residence	Not Public Information

Internet Information

Type	Address
Business Email	mandy.sample@oneamerica.com
Personal Email	msample@bblouisville.com

Phone Information

Type	Phone
Business / Home Office	(502) 724-5392