DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Synergence Group, Inc.	DOIID	526302	NAIC NPN	3952494

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Administrator	Not Applicable	6/19/2002	7/16/2007
Inactive	Non Resident	Agent	Health	6/1/2001	4/24/2008
Inactive	Non Resident	Agent	Life	6/1/2001	4/24/2008
Inactive	Non Resident	Agent	Casualty	11/19/2002	4/24/2008
Inactive	Non Resident	Agent	Property	11/19/2002	4/24/2008
* 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	United States Life Insurance Company in the City of New York	301126	Agent - Health	6/1/2001	4/24/2008
Inactive	United States Life Insurance Company in the City of New York	301126	Agent - Life	6/1/2001	4/24/2008

Designated Individuals

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Ballard, Daniel Joseph	369849	Agent - Casualty	11/19/2002	1/9/2004
Inactive	Ballard, Daniel Joseph	369849	Agent - Property	11/19/2002	1/9/2004
Inactive	Friday, Denise Susan	382322	Administrator - Not Applicable	9/1/2006	7/16/2008
Inactive	Friday, Denise Susan	382322	Agent - Casualty	11/19/2002	4/24/2008
Inactive	Friday, Denise Susan	382322	Agent - Health	6/1/2001	4/24/2008
Inactive	Friday, Denise Susan	382322	Agent - Life	6/1/2001	4/24/2008
Inactive	Friday, Denise Susan	382322	Agent - Property	11/19/2002	4/24/2008
Inactive	Headley, Peter Fredericks	330054	Administrator - Not Applicable	6/19/2002	7/1/2005
Inactive	Headley, Peter Fredericks	330054	Agent - Health	6/1/2001	1/9/2004
Inactive	Headley, Peter Fredericks	330054	Agent - Life	6/1/2001	1/9/2004
Inactive	Hudson, Beverly Gray	561869	Agent - Casualty	1/9/2004	4/24/2008
Inactive	Hudson, Beverly Gray	561869	Agent - Health	1/9/2004	4/24/2008
Inactive	Hudson, Beverly Gray	561869	Agent - Life	1/9/2004	4/24/2008
Inactive	Hudson, Beverly Gray	561869	Agent - Property	1/9/2004	4/24/2008