DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Burgess, Geoffrey M	DOIID	912234	NAIC NPN	2326431

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	4/11/2016	8/31/2018
Inactive	Non Resident	Agent	Life	4/11/2016	8/31/2018
* 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	Berkshire Life Insurance Company of America	300983	Agent - Health	5/3/2016	9/24/2018
Inactive	Berkshire Life Insurance Company of America	300983	Agent - Life	5/3/2016	9/24/2018
Inactive	Guardian Insurance & Annuity Company Inc. (The)	301920	Agent - Life	5/3/2016	8/31/2018
Inactive	Guardian Life Insurance Company of America	301316	Agent - Health	5/3/2016	8/31/2018
Inactive	Guardian Life Insurance Company of America	301316	Agent - Life	5/3/2016	8/31/2018
Inactive	Jackson National Life Insurance Company	300486	Agent - Life	3/22/2017	8/31/2018

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	MML Insurance Agency LLC	398679	Agent - Life	5/9/2017	8/31/2018
Inactive	MML Insurance Agency LLC	398679	Agent - Health	5/9/2017	8/31/2018