DEPARTMENT OF INSURANCE

Affiliations

Name	Creditors Insurance Service Inc.	DOIID	399038	NAIC NPN	3319553

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Health	7/23/1993	5/31/2003
Inactive	Non Resident	Agent	Life	7/23/1993	5/31/2003
* 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	Chase Insurance Life and Annuity Company	300518	Agent - Health	6/17/1997	5/31/2003
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Life	6/17/1997	5/31/2003
Inactive	Fidelity Life Association, A Legal Reserve Life Insurance Company	300774	Agent - Health	4/21/2000	5/31/2003
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Health	5/16/1994	5/31/2003
Inactive	Fidelity Security Life Insurance Company	300466	Agent - Life	5/16/1994	5/31/2003
Inactive	Fresenius Health Plans Insurance Company	300180	Agent - Health	9/28/1993	3/31/1999
Inactive	Fresenius Health Plans Insurance Company	300180	Agent - Life	9/28/1993	3/31/1999
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Health	7/12/2000	5/31/2003
Inactive	Illinois Mutual Life Insurance Company	301479	Agent - Life	7/12/2000	5/31/2003
Inactive	Kentucky Home Life Insurance Company	300477	Agent - Health	11/24/1998	5/31/2003
Inactive	Kentucky Home Life Insurance Company	300477	Agent - Life	11/24/1998	5/31/2003
Inactive	Life Insurance Company of the Southwest	301867	Agent - Health	4/24/1996	12/22/1997
Inactive	Life Insurance Company of the Southwest	301867	Agent - Life	4/24/1996	12/22/1997
Inactive	Midland Life Insurance Company (The)	300310	Agent - Health	5/24/1999	3/12/2002
Inactive	Midland Life Insurance Company (The)	300310	Agent - Life	5/24/1999	3/12/2002
Inactive	National Guardian Life Insurance Company	300596	Agent - Health	7/23/1993	12/1/1998
Inactive	National Guardian Life Insurance Company	300596	Agent - Life	7/23/1993	12/1/1998
Inactive	Paul Revere Life Insurance Company	300971	Agent - Health	5/1/2000	5/31/2003
Inactive	Paul Revere Life Insurance Company	300971	Agent - Life	5/1/2000	5/31/2003
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	5/1/2000	5/31/2003
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	5/1/2000	5/31/2003
Inactive	Reassure America Life Insurance Company	300678	Agent - Health	3/12/2002	4/28/2003
Inactive	Reassure America Life Insurance Company	300678	Agent - Life	3/12/2002	4/28/2003
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	5/1/2000	5/31/2003
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	5/1/2000	5/31/2003
Inactive	Voyager Life Insurance Company	301190	Agent - Health	5/26/1994	11/12/1998
Inactive	Voyager Life Insurance Company	301190	Agent - Life	5/26/1994	11/12/1998

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Gohmann, Martin Thomas	364117	Agent - Health	7/23/1993	5/31/2003
Inactive	Gohmann, Martin Thomas	364117	Agent - Life	7/23/1993	5/31/2003
Inactive	Morris, Joseph Jerome	335281	Agent - Health	9/28/1993	5/31/2003
Inactive	Morris, Joseph Jerome	335281	Agent - Life	9/28/1993	5/31/2003