Individual Information

DANIEL M MARTIN

BLOOMINGTON, IL 61704

Active

dan.martin.qlv1@statefarm.com

09/09/2019

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res Producer/Producer Firm	3472626	09/09/2019	Active	09/09/2019	09/30/2028

Qualification Type	Original Issue Date	Status	Effective Date
Casualty	09/09/2019	Active	09/09/2019
Health	09/09/2019	Active	09/09/2019
Life	09/09/2019	Active	09/09/2019
Property	09/09/2019	Active	09/09/2019
Var. Annuities/Var. Life	09/09/2019	Active	09/09/2019

Company Name	Appointment Type	Status	Active Date
105464
AMERICAN PET INSURANCE COMPANY	Property	Active	01/13/2021
159454
Company Name	Appointment Type	Status	Active Date
HIROAD ASSURANCE COMPANY	Casualty	Active	07/16/2025
	Property	Active	07/16/2025
897
Company Name	Appointment Type	Status	Active Date
JACKSON NATIONAL LIFE INSURANCE COMPANY	Life	Active	01/10/2022
	Var. Annuities/Var. Life	Active	01/10/2022
512
Company Name	Appointment Type	Status	Active Date
PACIFIC LIFE INSURANCE COMPANY	Health	Active	05/05/2025
	Life	Active	05/05/2025
	Var. Annuities/Var. Life	Active	05/13/2025
613
Company Name	Appointment Type	Status	Active Date
STATE FARM FIRE & CASUALTY COMPANY	Casualty	Active	03/16/2020
	Property	Active	03/16/2020
615
Company Name	Appointment Type	Status	Active Date
STATE FARM LIFE INSURANCE COMPANY	Life	Active	06/21/2022
	Var. Annuities/Var. Life	Active	12/22/2021
616
Company Name	Appointment Type	Status	Active Date
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY	Casualty	Active	05/25/2022
	Health	Active	12/22/2021
	Property	Active	05/25/2022

row(s) 1 - 15 of 15

Organization	Association Type	Type	Beg dte	End dte
INSURANCE PLACEMENT SERVICES INC	Designated Resp Lic Prdcr	Agency	01/20/2025	-

1 - 1