DEPARTMENT OF INSURANCE

Affiliations

Name	Carlock, Jesse Clyde	DOIID	307515	NAIC NPN	7159000

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Life	10/26/1990	8/31/2009
Inactive	Resident	Agent	Health	10/26/1990	8/31/2009
Inactive	Resident	Agent	General Lines	12/7/1990	10/25/1999
AFFIDAVIT ON FILE
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Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	American Select Insurance Company	301229	Agent - General Lines	5/6/1999	10/25/1999
Inactive	Anthem Life Insurance Company	301209	Agent - Health	9/3/1996	8/31/2009
Inactive	Anthem Life Insurance Company	301209	Agent - Life	9/3/1996	8/31/2009
Inactive	Continental General Insurance Company	300691	Agent - Health	10/25/1994	3/31/1997
Inactive	Continental General Insurance Company	300691	Agent - Life	10/25/1994	3/31/1997
Inactive	Golden Rule Insurance Company	301943	Agent - Health	10/26/1990	8/31/2009
Inactive	Golden Rule Insurance Company	301943	Agent - Life	10/26/1990	8/31/2009
Inactive	Grange Indemnity Insurance Company	300793	Agent - General Lines	11/13/1997	10/11/1999
Inactive	Grange Insurance Company	300234	Agent - General Lines	5/15/1992	10/11/1999
Inactive	Grange Life Insurance Company	300128	Agent - Health	5/14/1992	10/11/1999
Inactive	Grange Life Insurance Company	300128	Agent - Life	5/14/1992	10/11/1999
Inactive	Guarantee Life Insurance Company	301560	Agent - Health	12/5/1990	9/8/2000
Inactive	Guarantee Life Insurance Company	301560	Agent - Life	12/5/1990	9/8/2000
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Health	9/8/2000	7/2/2007
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Life	9/8/2000	7/2/2007
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Health	7/2/2007	3/18/2009
Inactive	Lincoln National Life Insurance Company (The)	301382	Agent - Life	7/2/2007	3/18/2009
Inactive	Ohio Farmers Insurance Company	301667	Agent - General Lines	12/7/1990	10/25/1999
Inactive	Omni Insurance Company	301545	Agent - General Lines	12/18/1990	3/31/1998
Inactive	Time Insurance Company	300683	Agent - Health	1/30/2001	11/15/2002
Inactive	Time Insurance Company	300683	Agent - Life	1/30/2001	11/15/2002
Inactive	Westfield Insurance Company	301950	Agent - General Lines	12/7/1990	10/25/1999
Inactive	Westfield National Insurance Company	301036	Agent - General Lines	12/7/1990	10/25/1999

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Acordia of Louisville Inc.	401252	Agent - Life	8/27/1996	5/31/2003
Inactive	Acordia of Louisville Inc.	401252	Agent - Health	8/27/1996	5/31/2003
Inactive	Arison Insurance Services, Inc.	401001	Agent - Life	6/25/1996	6/21/2008
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	6/25/1996	6/21/2008
Inactive	Healthplan Services, Inc.	401230	Agent - Health	8/31/1995	3/31/1997