DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Klar, Michael Jay	DOIID	516966	NAIC NPN	668495

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	4/16/2001	5/10/2006
Inactive	Non Resident	Agent	Life	10/26/2000	5/15/2006
* 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	Amica Life Insurance Company	301676	Agent - Life	10/26/2000	6/1/2006
Inactive	C.M. Life Insurance Company	301335	Agent - Health	1/20/2004	5/10/2006
Inactive	C.M. Life Insurance Company	301335	Agent - Life	1/20/2004	5/15/2006
Inactive	John Hancock Life Insurance Company	300821	Agent - Health	4/16/2001	6/20/2006
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	4/16/2001	6/20/2006
Inactive	John Hancock Variable Life Insurance Company	301914	Agent - Health	4/16/2001	6/20/2006
Inactive	John Hancock Variable Life Insurance Company	301914	Agent - Life	4/16/2001	6/20/2006
Inactive	Massachusetts Mutual Life Insurance Company	300445	Agent - Health	1/20/2004	5/10/2006
Inactive	Massachusetts Mutual Life Insurance Company	300445	Agent - Life	1/20/2004	5/10/2006
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	11/20/2003	5/10/2006
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	11/20/2003	5/10/2006
Inactive	Time Insurance Company	300683	Agent - Health	11/19/2003	3/22/2004
Inactive	Time Insurance Company	300683	Agent - Life	11/19/2003	3/22/2004
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	11/20/2003	5/10/2006
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	11/20/2003	5/15/2006

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Amica General Agency, LLC	509383	Agent - Life	5/18/2001	5/10/2006
Inactive	Amica General Agency, LLC	509383	Agent - Health	5/18/2001	6/12/2006