DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Green, Thomas Michael	DOIID	540058	NAIC NPN	2476839

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Property	6/20/2002	6/25/2019
Inactive	Non Resident	Agent	Casualty	6/20/2002	6/25/2019
Inactive	Non Resident	Agent	Life	10/23/2001	6/25/2019
Inactive	Non Resident	Agent	Health	10/23/2001	6/25/2019
* 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	Aetna Health Inc. (PA)	660717	Agent - Health	9/5/2013	6/25/2019
Inactive	Aetna Life Insurance Company	301140	Agent - Health	9/5/2013	6/25/2019
Inactive	Aetna Life Insurance Company	301140	Agent - Life	9/5/2013	6/25/2019
Inactive	National Guardian Life Insurance Company	300596	Agent - Health	7/26/2006	5/18/2008
Inactive	National Guardian Life Insurance Company	300596	Agent - Life	7/26/2006	5/18/2008
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	10/23/2001	12/11/2002
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	10/23/2001	12/11/2002
Inactive	ReliaStar Life Insurance Company	301712	Agent - Health	1/11/2006	6/25/2019
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	1/11/2006	6/25/2019
Inactive	ReliaStar Life Insurance Company of New York	301018	Agent - Health	1/11/2006	6/25/2008
Inactive	ReliaStar Life Insurance Company of New York	301018	Agent - Life	1/11/2006	6/25/2008
Inactive	Safety National Casualty Corporation	300390	Agent - Casualty	3/1/2004	6/25/2019
Inactive	Safety National Casualty Corporation	300390	Agent - Property	3/1/2004	6/25/2019
Inactive	Zurich American Insurance Company	301121	Agent - Casualty	6/20/2002	6/25/2019
Inactive	Zurich American Insurance Company	301121	Agent - Property	6/20/2002	6/25/2019

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Premier Insurance Management Services, Inc.	540070	Agent - Life	6/22/2010	6/4/2019
Inactive	Premier Insurance Management Services, Inc.	540070	Agent - Health	6/22/2010	6/4/2019
Inactive	Premier Insurance Management Services, Inc.	540070	Agent - Casualty	7/19/2002	6/4/2019
Inactive	Premier Insurance Management Services, Inc.	540070	Agent - Property	7/19/2002	6/4/2019