DEPARTMENT OF INSURANCE

Name	Shively, Robert M	DOIID	351837	NAIC NPN	628899

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Inactive	Non Resident	Agent	Health	9/26/1995	6/30/2006
Inactive	Non Resident	Agent	Life	9/26/1995	6/30/2006

*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	6101 Carnegie Blvd Suite 200Charlotte, NC 28209
Residence	Not Public Information