DEPARTMENT OF INSURANCE

Affiliations

Name	Eiss, Mitchell H	DOIID	644913	NAIC NPN	955492

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Life	11/27/2006	12/31/2012
Inactive	Non Resident	Agent	Health	11/27/2006	12/31/2012
Inactive	Non Resident	Agent	Variable Life and Variable Annuities	11/27/2006	12/31/2012
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Notice: The Department verifies, at the time of application for a Variable Life and Variable Annuity line of authority, that an agent is registered with the Financial Industry Regulatory Authority (FINRA) and the applicant has passed the Series 6 or greater exam. The Department does not verify registration with FINRA after the agent is qualified by the Department to receive the Variable Life and Variable Annuity line of authority. If you have questions about a broker’s FINRA registration status, you should check this status directly with FINRA.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Empower Annuity Insurance Company	300168	Agent - Life	7/31/2008	12/31/2012
Inactive	Empower Annuity Insurance Company	300168	Agent - Variable Life and Variable Annuities	7/31/2008	12/31/2012
Inactive	New York Life Insurance Company	300431	Agent - Health	10/30/2007	4/25/2012
Inactive	New York Life Insurance Company	300431	Agent - Life	10/30/2007	4/25/2012
Inactive	New York Life Insurance and Annuity Corporation	300726	Agent - Health	12/8/2006	4/25/2012
Inactive	New York Life Insurance and Annuity Corporation	300726	Agent - Life	12/8/2006	4/25/2012
Inactive	New York Life Insurance and Annuity Corporation	300726	Agent - Variable Life and Variable Annuities	12/8/2006	4/25/2012
Inactive	Prudential Insurance Company of America	300784	Agent - Health	7/31/2008	12/31/2012
Inactive	Prudential Insurance Company of America	300784	Agent - Life	7/31/2008	12/31/2012
Inactive	Prudential Insurance Company of America	300784	Agent - Variable Life and Variable Annuities	7/31/2008	12/31/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	NYLIFE Securities, LLC	645470	Agent - Life	12/8/2006	5/3/2012
Inactive	NYLIFE Securities, LLC	645470	Agent - Health	12/8/2006	5/11/2012
Inactive	NYLIFE Securities, LLC	645470	Agent - Variable Life and Variable Annuities	12/8/2006	5/3/2012