DEPARTMENT OF INSURANCE

Name	Ellis, Chad Matthew	DOIID	547477	NAIC NPN	2206689

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date
Inactive	Non Resident	Agent	Life	4/4/2002	6/30/2013
Inactive	Non Resident	Agent	Casualty	3/26/2004	6/30/2013
Inactive	Non Resident	Agent	Health	4/4/2002	6/30/2013
Inactive	Non Resident	Agent	Property	3/26/2004	6/30/2013

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

No License Renewal Information

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Business / Home Office	7000 Midland Blvd Amelia, OH 45102
Residence	Not Public Information

Internet Information

Type	Address
Business Email	cellis@amig.com

Phone Information

Type	Phone
Business / Home Office	(800) 643-7770 Ext-6805