DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Thomas Christopher	DOIID	360677	NAIC NPN	1483043

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	4/4/1995	12/10/1998
Inactive	Non Resident	Agent	Life	4/4/1995	12/10/1998
* 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	American United Life Insurance Company	300498	Agent - Health	4/4/1995	12/10/1998
Inactive	American United Life Insurance Company	300498	Agent - Life	4/4/1995	12/10/1998
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Health	6/6/1995	9/14/1998
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Life	6/6/1995	9/14/1998
Inactive	Time Insurance Company	300683	Agent - Health	6/8/1995	3/31/1997
Inactive	Time Insurance Company	300683	Agent - Life	6/8/1995	3/31/1997

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	3/31/1997