DEPARTMENT OF INSURANCE

Affiliations

Name	Henderson, Jennifer Carrie	DOIID	550158	NAIC NPN	7288620

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Health	6/28/2002	5/31/2006
Inactive	Resident	Agent	Life	6/28/2002	5/31/2006
AFFIDAVIT ON FILE
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Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Health	11/21/2003	5/31/2006
Inactive	Chase Insurance Life and Annuity Company	300518	Agent - Life	11/21/2003	5/31/2006
Inactive	Everlake Life Insurance Company	300873	Agent - Life	9/30/2003	1/14/2004
Inactive	Fidelity & Guaranty Life Insurance Company	301359	Agent - Life	2/27/2003	9/4/2003
Inactive	Glenbrook Life and Annuity Company	301384	Agent - Life	9/30/2003	1/14/2004
Inactive	Lafayette Life Insurance Company (The)	301039	Agent - Health	6/28/2002	9/4/2003
Inactive	Lafayette Life Insurance Company (The)	301039	Agent - Life	6/28/2002	9/4/2003
Inactive	Life Insurance Company of the Southwest	301867	Agent - Health	7/22/2002	9/15/2003
Inactive	Life Insurance Company of the Southwest	301867	Agent - Life	7/22/2002	9/15/2003
Inactive	Life Investors Insurance Company of America	301793	Agent - Life	9/30/2003	2/11/2004
Inactive	National Life Insurance Company	301852	Agent - Health	7/22/2002	9/15/2003
Inactive	National Life Insurance Company	301852	Agent - Life	7/22/2002	9/15/2003
Inactive	Nationwide Life and Annuity Insurance Company	300714	Agent - Life	9/30/2003	2/9/2004
Inactive	Physicians Life Insurance Company	300924	Agent - Life	5/15/2003	9/27/2004
Inactive	ReliaStar Life Insurance Company	301712	Agent - Health	10/7/2002	9/19/2003
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	10/7/2002	9/19/2003
Inactive	Security-Connecticut Life Insurance Company	300316	Agent - Life	10/7/2002	9/4/2003
Inactive	Southland Life Insurance Company	301175	Agent - Life	10/7/2002	9/12/2003
Inactive	Talcott Resolution Life and Annuity Insurance Company	300932	Agent - Health	8/5/2002	9/29/2003
Inactive	Talcott Resolution Life and Annuity Insurance Company	300932	Agent - Life	8/5/2002	9/29/2003
Inactive	Transamerica Life Insurance Company	300571	Agent - Life	9/8/2003	2/11/2004
Inactive	Western National Life Insurance Company	300461	Agent - Life	9/30/2003	1/6/2004

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	InsBanc, Inc.	520697	Agent - Health	3/14/2003	9/15/2003
Inactive	InsBanc, Inc.	520697	Agent - Life	3/14/2003	9/15/2003