DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Worth, Jeremy Michael	DOIID	362170	NAIC NPN	7196844

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Limited Line Credit	8/14/2000	8/31/2003
Inactive	Resident	Agent	Health	2/24/1997	5/14/1997
Inactive	Resident	Agent	Life	6/21/2000	8/31/2003
* 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	Central States Health and Life Company of Omaha	301874	Agent - Limited Line Credit	3/18/2002	12/12/2002
Inactive	Conseco Health Insurance Company	301725	Agent - Health	2/24/1997	5/14/1997
Inactive	Southern Financial Life Insurance Company	300664	Agent - Limited Line Credit	8/14/2000	12/26/2002
Inactive	Western National Life Insurance Company	300461	Agent - Life	6/21/2000	1/28/2003

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Natcity Insurance Services Inc.	400871	Agent - Life