Individual Information

MARK BURNSIDE GRAHAM

CLEARWATER, FL 33759-1005

Active

entity@amerilife.com

12/02/2010

License Type	License Number	Original Issue Date	Status	Effective Date	Expiration Date
Non-Res Producer/Producer Firm	502603	09/05/2006	Active	12/02/2010	12/31/2025

Qualification Type	Original Issue Date	Status	Effective Date
Health	09/05/2006	Active	12/02/2010
Life	09/05/2006	Active	12/02/2010

Company Name	Appointment Type	Status	Active Date
127606
BANKERS FIDELITY ASSURANCE COMPANY	Health	Active	07/18/2021
1612
Company Name	Appointment Type	Status	Active Date
BANKERS FIDELITY LIFE INSURANCE COMPANY	Health	Active	07/18/2021
	Life	Active	07/18/2021
505
Company Name	Appointment Type	Status	Active Date
CIGNA HEALTH AND LIFE INSURANCE COMPANY	Health	Active	10/02/2018
	Life	Active	10/02/2018
1320
Company Name	Appointment Type	Status	Active Date
CLEAR SPRING LIFE AND ANNUITY COMPANY	Life	Active	09/03/2020
1033
Company Name	Appointment Type	Status	Active Date
OHIO STATE LIFE INSURANCE COMPANY, THE	Health	Active	02/20/2020
	Life	Active	02/20/2020
512
Company Name	Appointment Type	Status	Active Date
PACIFIC LIFE INSURANCE COMPANY	Life	Active	08/07/2020
139
Company Name	Appointment Type	Status	Active Date
RENAISSANCE LIFE & HEALTH INSURANCE COMPANY OF AMERICA	Health	Active	07/19/2016
1451
Company Name	Appointment Type	Status	Active Date
UPSTREAM LIFE INSURANCE COMPANY	Life	Active	06/30/2020
714
Company Name	Appointment Type	Status	Active Date
WASHINGTON NATIONAL INSURANCE COMPANY	Health	Active	01/10/2017
	Life	Active	01/10/2017

row(s) 1 - 13 of 13

Organization	Association Type	Type	Beg dte	End dte
AAA MARKETING SERVICES LLC	Designated Resp Lic Prdcr	Agency	01/04/2022	-
1ST AMERICAN ESTATE PLANNING, LLC	Designated Resp Lic Prdcr	Agency	03/16/2020	-

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