DEPARTMENT OF INSURANCE

Affiliations

Name	Blacey, Charles Michael	DOIID	589559	NAIC NPN	8094010

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Resident	Agent	Health	6/10/2004	7/1/2006
Inactive	Resident	Agent	Life	6/10/2004	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	Allianz Life Insurance Company of North America	301791	Agent - Health	2/25/2005	7/1/2006
Inactive	Allianz Life Insurance Company of North America	301791	Agent - Life	2/25/2005	7/1/2006
Inactive	Americo Financial Life and Annuity Insurance Company	300869	Agent - Life	12/1/2004	8/19/2005
Inactive	Assurity Life Insurance Company	301099	Agent - Health	3/4/2005	7/1/2006
Inactive	Assurity Life Insurance Company	301099	Agent - Life	3/4/2005	7/1/2006
Inactive	Athene Annuity and Life Company	301893	Agent - Life	8/26/2004	4/20/2006
Inactive	Banner Life Insurance Company	301696	Agent - Life	2/21/2005	7/1/2006
Inactive	Fidelity & Guaranty Life Insurance Company	301359	Agent - Life	3/14/2005	7/1/2006
Inactive	First Colony Life Insurance Company	301179	Agent - Health	1/26/2005	7/1/2006
Inactive	First Colony Life Insurance Company	301179	Agent - Life	1/26/2005	7/1/2006
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Health	10/7/2004	7/1/2006
Inactive	Jefferson Pilot Financial Insurance Company	300756	Agent - Life	10/7/2004	7/1/2006
Inactive	Jefferson-Pilot Life Insurance Company	300379	Agent - Health	10/7/2004	7/1/2006
Inactive	Jefferson-Pilot Life Insurance Company	300379	Agent - Life	10/7/2004	7/1/2006
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Health	9/1/2004	7/1/2006
Inactive	John Hancock Life Insurance Company (U.S.A.)	300132	Agent - Life	9/1/2004	7/1/2006
Inactive	Pan-American Assurance Company	301533	Agent - Health	3/15/2005	5/11/2005
Inactive	Pan-American Assurance Company	301533	Agent - Life	3/15/2005	5/11/2005
Inactive	Pan-American Life Insurance Company	301530	Agent - Health	3/15/2005	5/11/2005
Inactive	Pan-American Life Insurance Company	301530	Agent - Life	3/15/2005	5/11/2005
Inactive	West Coast Life Insurance Company	301607	Agent - Life	8/25/2004	7/1/2006
Inactive		300277	Agent - Life	1/11/2005	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	Financial Resources Inc.	400687	Agent - Life	1/18/2005	7/1/2006
Inactive	Medlink Inc	400721	Agent - Health	2/21/2005	7/1/2006
Inactive	Medlink Inc	400721	Agent - Life	2/21/2005	7/1/2006