DEPARTMENT OF INSURANCE

Affiliations

Name	Ellis, Matthew Benjamin	DOIID	574592	NAIC NPN	7828495

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Life	8/25/2003	7/1/2006
Inactive	Resident	Agent	Health	8/25/2003	7/1/2006
* 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	8/25/2003	7/1/2006
Inactive	American Family Life Assurance Company of Columbus (AFLAC)	301781	Agent - Life	8/25/2003	7/1/2006
Inactive	C.M. Life Insurance Company	301335	Agent - Health	8/26/2004	6/6/2006
Inactive	C.M. Life Insurance Company	301335	Agent - Life	8/26/2004	6/6/2006
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	6/4/2004	7/1/2006
Inactive	Humana Insurance Company	301104	Agent - Health	11/4/2003	7/1/2006
Inactive	Humana Insurance Company	301104	Agent - Life	11/4/2003	7/1/2006
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Health	6/4/2004	7/1/2006
Inactive	Humana Insurance Company of Kentucky	300826	Agent - Life	6/4/2004	7/1/2006
Inactive	Massachusetts Mutual Life Insurance Company	300445	Agent - Health	8/26/2004	6/6/2006
Inactive	Massachusetts Mutual Life Insurance Company	300445	Agent - Life	8/26/2004	6/6/2006
Inactive	MedAmerica Insurance Company	301568	Agent - Health	2/20/2004	7/1/2006
Inactive	Pan-American Assurance Company	301533	Agent - Health	1/13/2004	7/1/2006
Inactive	Pan-American Assurance Company	301533	Agent - Life	1/13/2004	7/1/2006
Inactive	Pan-American Life Insurance Company	301530	Agent - Health	1/13/2004	7/1/2006
Inactive	Pan-American Life Insurance Company	301530	Agent - Life	1/13/2004	7/1/2006
Inactive	Protective Life Insurance Company	300638	Agent - Health	12/5/2003	6/8/2006
Inactive	Protective Life Insurance Company	300638	Agent - Life	12/5/2003	6/8/2006
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Health	6/16/2004	7/1/2006
Inactive	UnitedHealthcare Insurance Company	300946	Agent - Life	6/16/2004	7/1/2006
Inactive	UnitedHealthcare of Kentucky, Ltd.	301337	Agent - Health	6/16/2004	7/1/2006
Inactive	UnitedHealthcare of Ohio, Inc.	300493	Agent - Health	6/16/2004	7/1/2006

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	FSAB, LLC	576450	Agent - Health	9/19/2003	3/2/2005
Inactive	FSAB, LLC	576450	Agent - Life	9/19/2003	3/2/2005