DEPARTMENT OF INSURANCE

Affiliations

Name	Keith, Shirrel Wendell	DOIID	369435	NAIC NPN	7199907

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Health	9/28/1993	12/31/2000
Inactive	Resident	Agent	General Lines	5/3/1995	3/31/1996
Inactive	Resident	Agent	Life	9/28/1993	12/31/2000
* 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 Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	9/28/1993	3/20/1998
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	9/28/1993	3/20/1998
Inactive	American Fire and Casualty Company	300567	Agent - General Lines	5/3/1995	3/31/1996
Inactive	American Investors Life Insurance Company, Inc.	301358	Agent - Life	3/23/1995	10/26/1998
Inactive	American Republic Insurance Company	300861	Agent - Health	12/13/1993	12/18/1998
Inactive	American Republic Insurance Company	300861	Agent - Life	12/13/1993	12/18/1998
Inactive	Centennial Life Insurance Company (The)	301561	Agent - Health	1/18/1996	3/31/1997
Inactive	Centennial Life Insurance Company (The)	301561	Agent - Life	1/18/1996	3/31/1997
Inactive	Conseco Medical Insurance Company	300719	Agent - Health	1/9/1997	7/16/1998
Inactive	Conseco Medical Insurance Company	300719	Agent - Life	1/9/1997	7/16/1998
Inactive	Genworth Life Insurance Company	300623	Agent - Health	10/7/1996	12/1/2000
Inactive	Genworth Life Insurance Company	300623	Agent - Life	10/7/1996	12/1/2000
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	2/23/1995	12/1/2000
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	2/23/1995	12/1/2000
Inactive	Investors Life Insurance Company of Indiana	301657	Agent - Health	1/25/1995	3/31/1997
Inactive	Investors Life Insurance Company of Indiana	301657	Agent - Life	1/25/1995	3/31/1997
Inactive	Jackson National Life Insurance Company	300486	Agent - Health	8/12/1996	5/20/1999
Inactive	Jackson National Life Insurance Company	300486	Agent - Life	8/12/1996	5/20/1999
Inactive	John Alden Life Insurance Company	300573	Agent - Health	11/10/1993	3/31/1997
Inactive	John Alden Life Insurance Company	300573	Agent - Life	11/10/1993	3/31/1997
Inactive	LifeUSA Insurance Company	300386	Agent - Health	1/8/1998	12/1/2000
Inactive	LifeUSA Insurance Company	300386	Agent - Life	1/8/1998	12/1/2000
Inactive	MEGA Life and Health Insurance Company (The)	300751	Agent - Health	5/1/1996	3/31/1997
Inactive	MEGA Life and Health Insurance Company (The)	300751	Agent - Life	5/1/1996	3/31/1997
Inactive	Midland Life Insurance Company (The)	300310	Agent - Life	7/21/1994	12/1/2000
Inactive	North American Company for Life and Health Insurance	300291	Agent - Health	5/7/1997	12/1/2000
Inactive	North American Company for Life and Health Insurance	300291	Agent - Life	5/7/1997	12/1/2000
Inactive	Ohio Casualty Insurance Company	301492	Agent - General Lines	5/3/1995	3/31/1996
Inactive	Ohio Security Insurance Company	300622	Agent - General Lines	5/6/1995	3/31/1996
Inactive	Peoples Benefit Life Insurance Company	301895	Agent - Health	7/24/1997	4/13/1999
Inactive	Peoples Benefit Life Insurance Company	301895	Agent - Life	7/24/1997	4/13/1999
Inactive	Pioneer Life Insurance Company	300110	Agent - Health	6/20/1996	3/31/1997
Inactive	Pioneer Life Insurance Company	300110	Agent - Life	6/20/1996	3/31/1997
Inactive	ReliaStar Life Insurance Company	301712	Agent - Health	8/6/1996	12/1/2000
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	8/6/1996	12/1/2000
Inactive	Southern Security Life Insurance Company	300651	Agent - Life	6/21/1996	3/31/1997
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Health	1/26/1994	12/1/2000
Inactive	Standard Life and Accident Insurance Company	301534	Agent - Life	1/26/1994	12/1/2000
Inactive	Time Insurance Company	300683	Agent - Health	10/22/1993	12/29/2000
Inactive	Time Insurance Company	300683	Agent - Life	10/22/1993	12/29/2000
Inactive	Union Security Insurance Company	301844	Agent - Health	6/3/1998	12/31/2000
Inactive	Union Security Insurance Company	301844	Agent - Life	1/11/1994	12/31/2000
Inactive	West American Insurance Company	301112	Agent - General Lines	5/3/1995	3/31/1996

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Cornerstone Financial Corporation	399864	Agent - Life	8/16/1995	8/12/1996
Inactive	Cornerstone Financial Corporation	399864	Agent - Health	8/16/1995	8/12/1996
Inactive	Medlink Inc	400721	Agent - Life	7/15/1996	12/1/2000
Inactive	Medlink Inc	400721	Agent - Health	7/15/1996	12/1/2000