DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Mason, Grant Crockett	DOIID	306483	NAIC NPN	974377

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	5/29/1996	5/23/1997
Inactive	Non Resident	Agent	Life	5/29/1996	5/23/1997
Inactive	Non Resident	Agent	General Lines	5/29/1996	5/23/1997
* 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	Employers Insurance Company of Wausau	301813	Agent - General Lines	5/29/1996	5/23/1997
Inactive	Nationwide Life Insurance Company	300495	Agent - Health	5/29/1996	5/23/1997
Inactive	Nationwide Life Insurance Company	300495	Agent - Life	5/29/1996	5/23/1997
Inactive	Wausau Business Insurance Company	301476	Agent - General Lines	6/21/1996	5/23/1997
Inactive	Wausau Underwriters Insurance Company	301105	Agent - General Lines	6/21/1996	5/23/1997

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Companies Agency of Kentucky Inc.	400449	Agent - Life	3/6/1997	5/23/1997
Inactive	Companies Agency of Kentucky Inc.	400449	Agent - Health	3/6/1997	5/23/1997