DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Clifford, Jeremy M	DOIID	740676	NAIC NPN	7696478

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	10/21/2010	8/31/2012
Inactive	Non Resident	Agent	Life	10/21/2010	8/31/2012
* 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	Aetna Health Inc. (PA)	660717	Agent - Health	1/31/2011	11/23/2011
Inactive	Aetna Life Insurance Company	301140	Agent - Health	1/31/2011	11/23/2011
Inactive	Aetna Life Insurance Company	301140	Agent - Life	1/31/2011	11/23/2011
Inactive	Citizens Security Life Insurance Company	301257	Agent - Health	8/29/2011	11/7/2011
Inactive	CompBenefits Dental, Inc.	591692	Agent - Health	1/13/2011	8/31/2012
Inactive	Dental Concern Inc. (The)	301641	Agent - Health	1/13/2011	8/31/2012
Inactive	Humana Health Plan, Inc.	300142	Agent - Health	1/13/2011	8/31/2012
Inactive	Humana Insurance Company	301104	Agent - Health	1/13/2011	10/16/2012
Inactive	Humana Insurance Company	301104	Agent - Life	1/13/2011	10/16/2012
Inactive	HumanaDental Insurance Company	301457	Agent - Health	1/13/2011	2/23/2012
Inactive	HumanaDental Insurance Company	301457	Agent - Life	1/13/2011	2/23/2012
Inactive	Kanawha Insurance Company	300127	Agent - Health	1/13/2011	10/16/2012
Inactive	Kanawha Insurance Company	300127	Agent - Life	1/13/2011	10/16/2012

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Paychex Insurance Agency Inc	509469	Agent - Life	2/3/2011	12/12/2011
Inactive	Paychex Insurance Agency Inc	509469	Agent - Health	2/3/2011	12/12/2011