Agency Information

LAKE GROWTH

Address:

303 N 2ND ST STE 23A

ST CHARLES, IL 60174-1804

Phone

800-962-9141

URL:

Email:

markwillis@lakegrowth.com

National Producer Number:

16871060

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res. Producer Firm	3421878	03/13/2019	Active	01/06/2023	01/31/2026

Qualification Type	Original Issue Date	Status	Effective Date
Life	03/13/2019	Active	01/06/2023

Company Name	Appointment Type	Status	Active Date
476
ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA	Life	Active	05/08/2023
153630
Company Name	Appointment Type	Status	Active Date
AMERICAN LIFE & SECURITY CORP	Life	Active	04/12/2024
1190
Company Name	Appointment Type	Status	Active Date
SECURITY MUTUAL LIFE INSURANCE COMPANY OF NEW YORK	Life	Active	05/05/2023

row(s) 1 - 3 of 3

Name	Association Type	Agent	Begin Date	End Date
MARK WILLIS	Designated Resp Lic Prdcr	No	01/06/2023	-

1 - 1