DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Block, Michael Ira	DOIID	347411	NAIC NPN	255085

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	5/16/1997	11/30/2004
Inactive	Non Resident	Agent	Life	5/16/1997	11/30/2004
* 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	Americo Financial Life and Annuity Insurance Company	300869	Agent - Health	5/16/1997	11/30/2004
Inactive	Americo Financial Life and Annuity Insurance Company	300869	Agent - Life	5/16/1997	11/30/2004
Inactive	Assurity Life Insurance Company	301099	Agent - Health	5/13/1999	4/12/2002
Inactive	Assurity Life Insurance Company	301099	Agent - Life	5/13/1999	4/12/2002
Inactive	Great Southern Life Insurance Company	301443	Agent - Health	6/22/1998	2/4/2003
Inactive	Great Southern Life Insurance Company	301443	Agent - Life	6/22/1998	2/4/2003
Inactive	Transamerica Premier Life Insurance Company	300558	Agent - Health	6/3/1998	9/16/2002
Inactive	Transamerica Premier Life Insurance Company	300558	Agent - Life	6/3/1998	9/16/2002
Inactive	Union Labor Life Insurance Company	301832	Agent - Health	6/11/1999	9/3/2002
Inactive	Union Labor Life Insurance Company	301832	Agent - Life	6/11/1999	9/3/2002

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Ullico Select LLC	502043	Agent - Life	12/15/2003	2/2/2004
Inactive	Ullico Select LLC	502043	Agent - Health	12/15/2003	2/2/2004