DEPARTMENT OF INSURANCE

Affiliations

Name	Ellis, Chad Matthew	DOIID	547477	NAIC NPN	2206689

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Property	3/26/2004	6/30/2013
Inactive	Non Resident	Agent	Casualty	3/26/2004	6/30/2013
Inactive	Non Resident	Agent	Life	4/4/2002	6/30/2013
Inactive	Non Resident	Agent	Health	4/4/2002	6/30/2013
* 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	American Family Home Insurance Company	301817	Agent - Casualty	6/28/2007	3/19/2012
Inactive	American Family Home Insurance Company	301817	Agent - Property	6/28/2007	3/19/2012
Inactive	American Modern Home Insurance Company	300791	Agent - Casualty	6/28/2007	3/19/2012
Inactive	American Modern Home Insurance Company	300791	Agent - Property	6/28/2007	3/19/2012
Inactive	American Modern Select Insurance Company	581481	Agent - Casualty	6/28/2007	3/19/2012
Inactive	American Modern Select Insurance Company	581481	Agent - Property	6/28/2007	3/19/2012
Inactive	American Southern Home Insurance Company	626276	Agent - Casualty	9/26/2011	3/19/2012
Inactive	American Southern Home Insurance Company	626276	Agent - Property	9/26/2011	3/19/2012
Inactive	Jackson National Life Insurance Company	300486	Agent - Life	2/19/2003	3/5/2004
Inactive	Mid-West National Life Insurance Company of Tennessee	300097	Agent - Health	10/21/2002	12/28/2002
Inactive	Mid-West National Life Insurance Company of Tennessee	300097	Agent - Life	10/21/2002	12/28/2002
Inactive	Nationwide Life Insurance Company	300495	Agent - Life	4/10/2003	4/8/2004
Inactive	Nationwide Life and Annuity Insurance Company	300714	Agent - Life	4/10/2003	4/8/2004
Inactive	Primerica Life Insurance Company	300970	Agent - Health	4/4/2002	12/19/2002
Inactive	Primerica Life Insurance Company	300970	Agent - Life	4/4/2002	12/19/2002
Inactive	Talcott Resolution Life Insurance Company	301759	Agent - Health	3/13/2003	4/23/2004
Inactive	Talcott Resolution Life Insurance Company	301759	Agent - Life	3/13/2003	4/23/2004
Inactive	Talcott Resolution Life and Annuity Insurance Company	300932	Agent - Health	3/13/2003	4/22/2004
Inactive	Talcott Resolution Life and Annuity Insurance Company	300932	Agent - Life	3/13/2003	4/22/2004
Inactive	Western National Life Insurance Company	300461	Agent - Life	2/10/2003	3/8/2004

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Atlas Ins Agcy Inc	523813	Agent - Casualty	7/25/2007	3/19/2012
Inactive	Atlas Ins Agcy Inc	523813	Agent - Property	7/25/2007	3/19/2012
Denied	Fifth Third Insurance Agency Inc	399341	Agent - Life