DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Mudd, Jerome T	DOIID	381622	NAIC NPN	3102909

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Prepaid Dental Plan	9/12/2000	12/1/2000
Inactive	Resident	Agent	Health	7/10/1986	12/1/2000
Inactive	Resident	Agent	Life	7/10/1986	12/1/2000
* 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	Boston Mutual Life Insurance Company	300143	Agent - Health	6/25/1992	12/1/2000
Inactive	Boston Mutual Life Insurance Company	300143	Agent - Life	6/25/1992	12/1/2000
Inactive	Colonial Life and Accident Insurance Company	300846	Agent - Health	7/10/1986	12/20/1999
Inactive	Colonial Life and Accident Insurance Company	300846	Agent - Life	7/10/1986	12/20/1999
Inactive	Northern Life Insurance Company	300301	Agent - Health	9/8/1993	12/31/1998
Inactive	Northern Life Insurance Company	300301	Agent - Life	9/8/1993	12/31/1998

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Creative Employee Benefits, Inc.	400416	Agent - Life	6/27/1989	12/1/2000
Inactive	Creative Employee Benefits, Inc.	400416	Agent - Health	6/27/1989	12/1/2000
Inactive	Creative Employee Benefits, Inc.	400416	Agent - Prepaid Dental Plan	9/12/2000	12/1/2000