DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	National Concepts of KY Inc.	DOIID	401259	NAIC NPN	7222992

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Administrator	Not Applicable	5/24/1990	3/31/1991
Inactive	Resident	Agent	Health	5/31/2001	5/31/2004
Inactive	Resident	Agent	Life	5/14/1993	5/31/2004
* 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	Berkshire Life Insurance Company of America	300983	Agent - Health	6/27/2001	5/31/2004
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Life	6/27/2001	5/31/2004
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	9/12/1984	5/31/2004
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	9/12/1984	5/31/2004

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Black, Donald Joyce	371288	Agent - Health	9/12/1984	5/31/2004
Inactive	Black, Donald Joyce	371288	Agent - Life	9/12/1984	5/31/2004
Inactive	Smith, Samuel Douglas	393025	Agent - Health	12/9/1988	12/1/2000
Inactive	Smith, Samuel Douglas	393025	Agent - Life	12/9/1988	12/1/2000