DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Burgess, Robert J	DOIID	358831	NAIC NPN	7195374

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Credit Life & Health	9/12/1998	8/7/2000
Inactive	Resident	Agent	Limited Line Credit	7/28/2009	2/29/2012
* 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	Investors Heritage Life Insurance Company	300363	Agent - Credit Life & Health	9/12/1998	8/7/2000
Inactive	Investors Heritage Life Insurance Company	300363	Agent - Limited Line Credit	7/28/2009	2/29/2012
Denied	Protective Property & Casualty Insurance Company	300393	Agent - Limited Line Credit
Inactive	Southern Financial Life Insurance Company	300664	Agent - Limited Line Credit	5/17/2004	2/29/2008

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Cumberland Security Bank	399075	Agent - Limited Line Credit	1/14/2004	7/20/2006
Inactive	First & Farmers Bank, Inc.	398166	Agent - Limited Line Credit	2/28/2005	2/29/2008