DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Canfield, Jeffrey Mark	DOIID	502600	NAIC NPN	3331506

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Health	2/9/2000	12/31/2003
Inactive	Non Resident	Agent	Life	2/9/2000	5/15/2002
* 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 - Health	2/9/2000	1/27/2003
Inactive	Amica Life Insurance Company	301676	Agent - Life	2/9/2000	5/15/2002

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	5/15/2002
Inactive	Amica General Agency, LLC	509383	Agent - Health	6/22/2000	1/27/2003