DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Donnelly III, Edward Francis	DOIID	392589	NAIC NPN	2755768

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	3/17/1999	7/2/2002
Inactive	Non Resident	Agent	Health	10/5/2000	7/2/2002
* 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	Amica Life Insurance Company	301676	Agent - Life	3/17/1999	4/23/2002
Inactive	John Hancock Life Insurance Company	300821	Agent - Health	10/5/2000	7/2/2002
Inactive	John Hancock Life Insurance Company	300821	Agent - Life	10/5/2000	7/2/2002

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Amica General Agency, LLC	509383	Agent - Life	6/22/2000	7/1/2002
Inactive	Amica General Agency, LLC	509383	Agent - Health	3/23/2001	4/25/2002