DEPARTMENT OF INSURANCE

Affiliations

Name	Grimsley, Earl	DOIID	346778	NAIC NPN	3316434

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Life	4/5/1984	12/31/2011
Inactive	Resident	Agent	Health	4/5/1984	12/31/2011
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	Citizens Security Life Insurance Company	301257	Agent - Health	9/16/1992	12/7/2004
Inactive	Citizens Security Life Insurance Company	301257	Agent - Life	9/16/1992	12/7/2004
Inactive	Conseco Health Insurance Company	301725	Agent - Health	4/1/2002	8/7/2006
Inactive	Conseco Health Insurance Company	301725	Agent - Life	4/1/2002	8/7/2006
Inactive	Conseco Insurance Company	301202	Agent - Health	11/30/2004	1/23/2007
Inactive	Conseco Insurance Company	301202	Agent - Life	11/30/2004	1/23/2007
Inactive	Freedom Life Insurance Company of America	300074	Agent - Health	7/1/1998	8/31/1998
Inactive	Freedom Life Insurance Company of America	300074	Agent - Life	7/1/1998	8/31/1998
Inactive	Guarantee Trust Life Insurance Company	301043	Agent - Health	3/8/1985	12/31/2011
Inactive	Guarantee Trust Life Insurance Company	301043	Agent - Life	3/8/1985	12/31/2011
Inactive	Investors Heritage Life Insurance Company	300363	Agent - Health	12/15/1992	12/17/1998
Inactive	Investors Heritage Life Insurance Company	300363	Agent - Life	12/15/1992	12/17/1998
Inactive	Life Insurance Company of Alabama	301439	Agent - Health	2/3/1987	12/31/2011
Inactive	Life Insurance Company of Alabama	301439	Agent - Life	2/3/1987	12/31/2011
Inactive	ManhattanLife Insurance and Annuity Company	301795	Agent - Health	8/11/2006	12/31/2011
Inactive	ManhattanLife Insurance and Annuity Company	301795	Agent - Life	8/11/2006	12/31/2011
Inactive	National Foundation Life Insurance Company	300084	Agent - Health	4/5/1984	3/31/1997
Inactive	National Foundation Life Insurance Company	300084	Agent - Life	4/5/1984	3/31/1997
Inactive	ReliaStar Life Insurance Company	301712	Agent - Health	7/11/1991	3/31/1997
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	7/11/1991	3/31/1997
Inactive	Southwestern Life Insurance Company	301343	Agent - Health	6/29/1993	3/5/1999
Inactive	Southwestern Life Insurance Company	301343	Agent - Life	6/29/1993	3/5/1999
Inactive	Time Insurance Company	300683	Agent - Health	10/13/1998	1/28/2005
Inactive	Time Insurance Company	300683	Agent - Life	10/13/1998	1/28/2005

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Frank Bradshaw Co	399179	Agent - Life	4/22/1992	8/10/2000
Inactive	Frank Bradshaw Co	399179	Agent - Health	4/22/1992	8/10/2000
Inactive	Grimsley Insurance Agency Inc.	399862	Agent - Life	6/4/1993	12/31/2011
Inactive	Grimsley Insurance Agency Inc.	399862	Agent - Health	6/4/1993	12/31/2011