Notification of Changes for Business Entity
General Information
Business Entity Name:	HAMILTON INSURANCE GROUP, INC.
Incorporation / Formation Date:
FEIN:	34-1704045
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	RICHLAND
Business Address
Address 1:	1346 LEXINGTON AVE
Address 2:
City:	MANSFIELD
State:	OH
Zip:	44907
Phone:	419-526-4700
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1346 LEXINGTON AVE
Address 2:
City:	MANSFIELD
State:	OH
Zip:	44907
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	NO	New DBA/Trade Name:
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	YES

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
NATHAN JAY DONLEY	AGENT	987804	YES		11-09-2015

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date

Title Business Entities Only
1. Is any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance? (i.e. banking, auto dealer, mortgage company)	NO
2. Has any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance since the filing of the previous CN-65 or the original application?	NO
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement

Submitted By
Submitted By:	NEIL HAMILTON
Title:	PRESIDENT / CEO
Phone Number:	419-526-4700
Email Address:	NEIL@HAMILTONINS.NET