DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Lax Sr, Jerry Leigh	DOIID	393765	NAIC NPN	829776

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Life	5/25/1995	12/1/2000
Inactive	Resident	Agent	Health	5/25/1995	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	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	5/7/1996	3/28/2000
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	5/7/1996	3/28/2000
Inactive	American General Life and Accident Insurance Company	301362	Agent - Health	5/25/1995	6/3/1996
Inactive	American General Life and Accident Insurance Company	301362	Agent - Life	5/25/1995	6/3/1996
Inactive	United American Insurance Company	300910	Agent - Health	2/23/1996	12/31/1998
Inactive	United American Insurance Company	300910	Agent - Life	2/23/1996	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	West Kentucky Group Benefits	401049	Agent - Life	12/28/1998	12/1/2000
Inactive	West Kentucky Group Benefits	401049	Agent - Health	12/28/1998	12/1/2000