DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Staten, Gerald L	DOIID	555567	NAIC NPN	1468438

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	9/16/2002	3/31/2013
Inactive	Non Resident	Agent	Health	9/16/2002	3/31/2013
* 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 Life Assurance Company of Columbus (AFLAC)	301781	Agent - Health	11/15/2002	4/9/2013
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	11/15/2002	4/9/2013
Inactive	Anthem Life Insurance Company	301209	Agent - Health	6/6/2003	11/4/2010
Inactive	Anthem Life Insurance Company	301209	Agent - Life	6/6/2003	11/4/2010
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Health	8/2/2004	11/16/2011
Inactive	Hartford Life and Accident Insurance Company	300878	Agent - Life	8/2/2004	11/16/2011
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	5/17/2006	3/31/2013
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	5/17/2006	3/31/2013
Inactive	Union Security Insurance Company	301844	Agent - Health	8/1/2007	3/31/2013
Inactive	Union Security Insurance Company	301844	Agent - Life	8/1/2007	3/31/2013

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Arison Insurance Services, Inc.	401001	Agent - Health	6/11/2003	6/23/2008
Inactive	Arison Insurance Services, Inc.	401001	Agent - Life	6/11/2003	6/23/2008
Inactive	Designated Agent Company Inc.	681257	Agent - Health	6/30/2008	4/29/2011
Inactive	Designated Agent Company Inc.	681257	Agent - Life	6/30/2008	4/29/2011
Inactive	Leonard Insurance Services Agency, Inc.	520718	Agent - Health	12/8/2005	3/31/2013
Inactive	Leonard Insurance Services Agency, Inc.	520718	Agent - Life	12/8/2005	3/31/2013