DEPARTMENT OF INSURANCE

Affiliations

Name	Jackson, Derrick B	DOIID	504510	NAIC NPN	7211668

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Limited Line Credit	11/6/2000	8/31/2004
Inactive	Resident	Agent	Life	6/20/2000	7/1/2004
Inactive	Resident	Agent	Health	6/20/2000	7/1/2004
* 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	Augustar Life Insurance Company	301816	Agent - Life	10/28/2002	1/20/2004
Inactive	Empower Annuity Insurance Company of America	300259	Agent - Life	10/25/2002	11/13/2003
Inactive	Everlake Life Insurance Company	300873	Agent - Life	9/23/2003	11/20/2003
Inactive	Glenbrook Life and Annuity Company	301384	Agent - Life	9/23/2003	11/20/2003
Inactive	Golden Rule Insurance Company	301943	Agent - Health	11/12/2002	7/1/2004
Inactive	Golden Rule Insurance Company	301943	Agent - Life	11/12/2002	7/1/2004
Inactive	Investors Heritage Life Insurance Company	300363	Agent - Limited Line Credit	11/6/2000	7/1/2004
Inactive	MetLife Investors USA Insurance Company	300845	Agent - Health	10/9/2003	7/1/2004
Inactive	MetLife Investors USA Insurance Company	300845	Agent - Life	10/9/2003	7/1/2004
Inactive	Nationwide Life and Annuity Insurance Company	300714	Agent - Life	9/22/2003	7/1/2004
Inactive	Protective Life Insurance Company	300638	Agent - Health	11/8/2002	7/1/2004
Inactive	Protective Life Insurance Company	300638	Agent - Life	11/8/2002	7/1/2004
Inactive	Security Benefit Life Insurance Company	300583	Agent - Health	8/18/2000	7/1/2004
Inactive	Security Benefit Life Insurance Company	300583	Agent - Life	8/18/2000	12/16/2002
Inactive	Symetra Life Insurance Company	301691	Agent - Health	4/11/2003	7/1/2004
Inactive	Symetra Life Insurance Company	301691	Agent - Life	4/11/2003	12/5/2003
Inactive	Transamerica Life Insurance Company	300571	Agent - Life	10/17/2002	7/1/2004
Inactive	Western National Life Insurance Company	300461	Agent - Life	7/17/2000	12/3/2003
Inactive	Western-Southern Life Assurance Company	301590	Agent - Health	10/16/2002	7/1/2004
Inactive	Western-Southern Life Assurance Company	301590	Agent - Life	10/16/2002	7/1/2004

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Fifth Third Insurance Agency Inc	399341	Agent - Life	10/19/2000	7/1/2004
Inactive	Fifth Third Insurance Agency Inc	399341	Agent - Health	10/19/2000	7/1/2004