DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Prouty, Jackson S	DOIID	607669	NAIC NPN	2286174

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	4/26/2005	7/31/2010
Inactive	Non Resident	Agent	Health	4/26/2005	7/31/2010
* 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 Heritage Life Insurance Company	300272	Agent - Health	4/12/2006	3/11/2009
Inactive	American Heritage Life Insurance Company	300272	Agent - Life	4/12/2006	3/11/2009
Inactive	Boston Mutual Life Insurance Company	300143	Agent - Health	7/5/2005	7/31/2010
Inactive	Boston Mutual Life Insurance Company	300143	Agent - Life	7/5/2005	7/31/2010
Inactive	Kanawha Insurance Company	300127	Agent - Health	9/13/2005	7/31/2010
Inactive	Kanawha Insurance Company	300127	Agent - Life	9/13/2005	7/31/2010
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Health	6/28/2005	7/31/2010
Inactive	Provident Life and Accident Insurance Company	301525	Agent - Life	6/28/2005	7/31/2010
Inactive	ReliaStar Life Insurance Company	301712	Agent - Health	6/13/2005	7/31/2010
Inactive	ReliaStar Life Insurance Company	301712	Agent - Life	6/13/2005	7/31/2010
Inactive	ReliaStar Life Insurance Company of New York	301018	Agent - Health	6/13/2005	6/25/2008
Inactive	ReliaStar Life Insurance Company of New York	301018	Agent - Life	6/13/2005	6/25/2008
Inactive	Trustmark Insurance Company	300317	Agent - Health	6/4/2005	7/31/2010
Inactive	Trustmark Insurance Company	300317	Agent - Life	6/4/2005	7/31/2010
Inactive	UNUM Life Insurance Company of America	300817	Agent - Health	1/30/2008	7/31/2010
Inactive	UNUM Life Insurance Company of America	300817	Agent - Life	1/30/2008	7/31/2010

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	The Farmington Company	534046	Agent - Life	6/27/2005	7/31/2010
Inactive	The Farmington Company	534046	Agent - Health	6/27/2005	7/31/2010