DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Stephens, Jerry Michael	DOIID	359035	NAIC NPN	4773293

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Health	10/1/1992	7/1/1996
Inactive	Resident	Agent	Life	10/1/1992	7/1/1996
* 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	Northwestern Mutual Life Insurance Company	300931	Agent - Health	10/1/1992	4/29/1996
Inactive	Northwestern Mutual Life Insurance Company	300931	Agent - Life	10/1/1992	4/29/1996
Inactive	Principal Life Insurance Company	300129	Agent - Health	3/3/1994	7/1/1996
Inactive	Principal Life Insurance Company	300129	Agent - Life	3/3/1994	7/1/1996
Inactive	Time Insurance Company	300683	Agent - Health	11/16/1993	7/1/1996
Inactive	Time Insurance Company	300683	Agent - Life	11/16/1993	7/1/1996

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Healthplan Services, Inc.	401230	Agent - Health	8/31/1995	7/1/1996