DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Lakes, Manuel	DOIID	331124	NAIC NPN	7178155

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Agent	Health	12/6/1983	4/30/2009
Inactive	Resident	Agent	Life	12/6/1983	4/30/2009
AFFIDAVIT ON FILE
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Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Columbian Life Insurance Company	300810	Agent - Health	5/14/1998	7/14/2001
Inactive	Columbian Life Insurance Company	300810	Agent - Life	5/14/1998	7/14/2001
Inactive	Forethought Life Insurance Company	301407	Agent - Life	7/14/1994	2/27/2003
Inactive	Franklin American Life Insurance Company	300563	Agent - Health	4/7/1997	7/7/1999
Inactive	Franklin American Life Insurance Company	300563	Agent - Life	4/7/1997	7/7/1999
Inactive	Golden Rule Insurance Company	301943	Agent - Health	7/27/1990	3/31/1997
Inactive	Golden Rule Insurance Company	301943	Agent - Life	7/27/1990	3/31/1997
Inactive	IA American Life Insurance Company	301149	Agent - Health	1/6/1994	2/1/2005
Inactive	IA American Life Insurance Company	301149	Agent - Life	1/6/1994	8/16/2002
Inactive	Investors Heritage Life Insurance Company	300363	Agent - Health	6/2/1989	4/30/2009
Inactive	Investors Heritage Life Insurance Company	300363	Agent - Life	6/2/1989	4/30/2009
Inactive	Lincoln Memorial Life Insurance Company	300463	Agent - Life	10/31/1995	3/31/1997
Inactive	Pierce National Life Insurance Company	301847	Agent - Life	12/22/1989	3/16/2000
Inactive	Primerica Life Insurance Company	300970	Agent - Health	12/6/1983	12/9/1998
Inactive	Primerica Life Insurance Company	300970	Agent - Life	12/6/1983	12/9/1998
Inactive	Transamerica Premier Life Insurance Company	300558	Agent - Health	12/15/1993	12/31/1998
Inactive	Transamerica Premier Life Insurance Company	300558	Agent - Life	12/15/1993	12/31/1998

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Berea Funeral Service Inc.	401024	Agent - Life	6/6/1996	5/8/2006