DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Headley, Peter Fredericks	DOIID	330054	NAIC NPN	255889

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Administrator	Not Applicable	3/22/1991	7/1/2005
Inactive	Non Resident	Agent	Life	8/18/1989	9/13/2004
Inactive	Non Resident	Agent	Health	8/18/1989	9/13/2004
* 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	Ameritas Life Insurance Corporation	300126	Agent - Health	8/13/1993	9/13/2004
Inactive	Ameritas Life Insurance Corporation	300126	Agent - Life	8/13/1993	9/13/2004
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Health	1/4/2000	8/2/2004
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Life	1/4/2000	8/2/2004
Inactive	Jackson National Life Insurance Company	300486	Agent - Health	9/27/1991	12/17/1998
Inactive	Jackson National Life Insurance Company	300486	Agent - Life	5/19/1999	2/12/2003
Inactive	John Hancock Life Insurance Company	300821	Agent - Health	10/4/1996	9/13/2004
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	10/4/1996	9/13/2004
Inactive	Life Investors Insurance Company of America	301793	Agent - Health	10/30/1996	3/10/2004
Inactive	Life Investors Insurance Company of America	301793	Agent - Life	10/30/1996	3/10/2004
Inactive	Physicians Mutual Insurance Company	301084	Agent - Health	3/19/1991	4/30/2004
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	8/18/1989	4/23/2004
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	8/18/1989	4/23/2004
Inactive	Talcott Resolution Life Insurance Company	301759	Agent - Health	1/4/2000	8/2/2004
Inactive	Talcott Resolution Life Insurance Company	301759	Agent - Life	1/4/2000	8/2/2004
Inactive	United States Life Insurance Company in the City of New York	301126	Agent - Health	8/20/1997	5/25/2001
Inactive	United States Life Insurance Company in the City of New York	301126	Agent - Life	8/20/1997	5/25/2001

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	AMA Insurance Agency Inc.	396159	Administrator - Not Applicable	3/22/1991	3/29/2005
Inactive	AMA Insurance Agency Inc.	396159	Agent - Life	1/31/2001	1/9/2004
Inactive	AMA Insurance Agency Inc.	396159	Agent - Health	1/31/2001	1/9/2004
Inactive	Synergence Group, Inc.	526302	Administrator - Not Applicable	6/19/2002	7/1/2005
Inactive	Synergence Group, Inc.	526302	Agent - Life	6/1/2001	1/9/2004
Inactive	Synergence Group, Inc.	526302	Agent - Health	6/1/2001	1/9/2004