DEPARTMENT OF INSURANCE

Affiliations

Name	Guilliom, Brian A	DOIID	356787	NAIC NPN	1032066

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Life	10/2/1986	8/31/2007
Inactive	Resident	Agent	Health	10/2/1986	8/31/2007
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	Ameritas Life Insurance Corporation	300126	Agent - Health	10/31/1995	3/31/1997
Inactive	Ameritas Life Insurance Corporation	300126	Agent - Life	10/31/1995	3/31/1997
Inactive	C.M. Life Insurance Company	301335	Agent - Health	2/12/1997	8/19/1999
Inactive	C.M. Life Insurance Company	301335	Agent - Life	2/12/1997	8/19/1999
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Health	11/7/1988	4/1/2007
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Life	11/7/1988	4/1/2007
Inactive	Empower Annuity Insurance Company of America	300259	Agent - Health	12/31/1991	10/8/1996
Inactive	Empower Annuity Insurance Company of America	300259	Agent - Life	12/31/1991	10/8/1996
Inactive	Fidelity Life Association, A Legal Reserve Life Insurance Company	300774	Agent - Health	3/20/1991	8/31/2007
Inactive	Fidelity Life Association, A Legal Reserve Life Insurance Company	300774	Agent - Life	3/20/1991	8/31/2007
Inactive	Guardian Insurance & Annuity Company Inc. (The)	301920	Agent - Health	6/8/1999	11/8/2000
Inactive	Guardian Insurance & Annuity Company Inc. (The)	301920	Agent - Life	6/8/1999	11/8/2000
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	4/29/1999	11/8/2000
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	4/29/1999	11/8/2000
Inactive	MML Bay State Life Insurance Company	301198	Agent - Health	10/25/1988	8/19/1999
Inactive	MML Bay State Life Insurance Company	301198	Agent - Life	10/25/1988	8/19/1999
Inactive	Massachusetts Mutual Life Insurance Company	300445	Agent - Health	3/19/1997	8/19/1999
Inactive	Massachusetts Mutual Life Insurance Company	300445	Agent - Life	3/19/1997	8/19/1999
Inactive	Midland Life Insurance Company (The)	300310	Agent - Health	11/15/1996	3/31/2001
Inactive	Midland Life Insurance Company (The)	300310	Agent - Life	11/15/1996	3/31/2001
Inactive	NYLIFE Insurance Company of Arizona	301642	Agent - Health	11/19/1998	2/5/1999
Inactive	NYLIFE Insurance Company of Arizona	301642	Agent - Life	11/19/1998	2/5/1999
Inactive	New York Life Insurance Company	300431	Agent - Health	11/19/1998	2/5/1999
Inactive	New York Life Insurance Company	300431	Agent - Life	11/19/1998	2/5/1999
Inactive	New York Life Insurance and Annuity Corporation	300726	Agent - Health	11/19/1998	2/5/1999
Inactive	New York Life Insurance and Annuity Corporation	300726	Agent - Life	11/19/1998	2/5/1999
Inactive	Protective Life Insurance Company	300638	Agent - Health	4/1/2007	8/31/2007
Inactive	Protective Life Insurance Company	300638	Agent - Life	4/1/2007	8/31/2007

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Insurance Inquiries Inc.	400086	Agent - Life	10/2/1986	5/31/2004
Inactive	Insurance Inquiries Inc.	400086	Agent - Health	10/2/1986	5/31/2004