DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Ross Jr, Timothy	DOIID	519783	NAIC NPN	1912984

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	1/12/2001	9/30/2004
Inactive	Non Resident	Agent	Health	6/22/2001	9/30/2004
* 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	Amica Life Insurance Company	301676	Agent - Life	1/12/2001	11/20/2003
Inactive	John Hancock Life Insurance Company	300821	Agent - Health	6/22/2001	9/30/2004
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	6/22/2001	9/30/2004

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	7/18/2001	6/23/2003
Inactive	Amica General Agency, LLC	509383	Agent - Health	7/18/2001	6/23/2003