DEPARTMENT OF INSURANCE

PUBLIC PROTECTION
CABINET

DEPARTMENT OF INSURANCE

Affiliations

Name	Jones, Jeremy A	DOIID	510871	NAIC NPN	3240087

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Non Resident	Agent	Life	5/4/2011	5/2/2012
Inactive	Non Resident	Agent	Health	5/4/2011	5/2/2012
* 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	Anthem Life Insurance Company	301209	Agent - Health	8/29/2011	5/2/2012
Inactive	Anthem Life Insurance Company	301209	Agent - Life	8/29/2011	5/2/2012
Inactive	United American Insurance Company	300910	Agent - Health	6/26/2000	8/10/2000
Inactive	United American Insurance Company	300910	Agent - Life	6/26/2000	8/10/2000
Inactive	Western National Life Insurance Company	300461	Agent - Life	3/8/2001	5/31/2003
Inactive	Western-Southern Life Assurance Company	301590	Agent - Life	3/8/2001	5/31/2003

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Denied	Fundamental Insurance and Retirement Planning	675147	Agent - Life
Denied	Fundamental Insurance and Retirement Planning	675147	Agent - Health