DEPARTMENT OF INSURANCE

Affiliations

Name	Ford, David Walter	DOIID	308548	NAIC NPN	2820808

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Administrator	Not Applicable	6/16/2003	10/31/2008
Inactive	Non Resident	Agent	Property	9/8/2005	10/31/2008
Inactive	Non Resident	Agent	Casualty	9/8/2005	10/31/2008
Inactive	Non Resident	Agent	Health	8/31/1999	10/31/2008
Inactive	Non Resident	Agent	Life	8/31/1999	10/31/2008
* 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	Allianz Life Insurance Company of North America	301791	Agent - Health	3/6/2003	8/1/2003
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	3/6/2003	8/1/2003
Inactive	Continental Casualty Company	301019	Agent - Health	8/31/1999	11/17/2005
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Health	1/17/2003	1/4/2007
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Life	1/17/2003	1/4/2007
Inactive	Genworth Life Insurance Company	300623	Agent - Health	3/18/2003	12/4/2007
Inactive	Genworth Life Insurance Company	300623	Agent - Life	3/18/2003	12/4/2007
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Health	4/27/2000	10/31/2008
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Life	4/27/2000	10/31/2008
Inactive	MassMutual Ascend Life Insurance Company	300320	Agent - Health	1/31/2003	7/29/2005
Inactive	MassMutual Ascend Life Insurance Company	300320	Agent - Life	1/31/2003	7/29/2005
Inactive	Penn Treaty Network America Insurance Company	301297	Agent - Health	5/14/2003	8/18/2004
Inactive	Penn Treaty Network America Insurance Company	301297	Agent - Life	5/14/2003	8/29/2005
Inactive	Prudential Insurance Company of America	300784	Agent - Health	1/2/2003	5/1/2007
Inactive	Prudential Insurance Company of America	300784	Agent - Life	1/2/2003	5/1/2007
Inactive	Talcott Resolution Life Insurance Company	301759	Agent - Health	4/27/2000	10/31/2008
Inactive	Talcott Resolution Life Insurance Company	301759	Agent - Life	4/27/2000	10/31/2008
Inactive	Union Security Insurance Company	301844	Agent - Health	12/27/2000	4/6/2007
Inactive	Union Security Insurance Company	301844	Agent - Life	12/27/2000	4/6/2007
Inactive	Virginia Surety Company, Inc.	301022	Agent - Casualty	8/2/2006	10/31/2008
Inactive	Virginia Surety Company, Inc.	301022	Agent - Property	8/2/2006	10/31/2008
Inactive	Wilcac Life Insurance Company	301573	Agent - Health	8/31/1999	12/30/2004
Inactive	Wilcac Life Insurance Company	301573	Agent - Life	8/31/1999	12/30/2004
Inactive	Wilton Reassurance Life Company of New York	300163	Agent - Life	8/19/2002	6/8/2006

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	FISI Madison Financial Corp.	401291	Agent - Life	6/13/2003	10/24/2004
Inactive	FISI Madison Financial Corp.	401291	Agent - Health	6/13/2003	10/24/2004
Inactive	FRANKLIN MADISON GROUP LLC	394568	Agent - Life	12/20/2006	10/31/2008
Inactive	FRANKLIN MADISON GROUP LLC	394568	Agent - Health	12/20/2006	10/31/2008
Inactive	FRANKLIN MADISON GROUP LLC	394568	Administrator - Not Applicable	6/16/2003	10/31/2008
Inactive	FRANKLIN MADISON GROUP LLC	394568	Agent - Casualty	12/20/2006	10/31/2008
Inactive	FRANKLIN MADISON GROUP LLC	394568	Agent - Property	12/20/2006	10/31/2008
Inactive	Long Term Preferred Care, Inc.	577837	Agent - Life	11/6/2003	10/31/2008
Inactive	Long Term Preferred Care, Inc.	577837	Agent - Health	11/6/2003	10/31/2008