Notification of Changes for Business Entity
General Information
Business Entity Name:	NAMELY EMPLOYEE BENEFITS LLC
Incorporation / Formation Date:
FEIN:	61-1804048
Ohio License Number:	1130498
NPN:	18178998
DBA / Trade Name:
State of Domicile:	DE
County:	USA
Business Address
Address 1:	195 BROADWAY
Address 2:	15TH FL
City:	NEW YORK
State:	NY
Zip:	10007
Phone:	347-263-7044
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	195 BROADWAY
Address 2:	15TH FL
City:	NEW YORK
State:	NY
Zip:	10007
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
MATTHEW MONAHAN	VICE PRESIDENT	7433052	YES		11/7/2018
CHRISTOPHER MARINCIK	DIRECTOR	8345153	YES		11/7/2018
VINCENT DIDONNA	DIRECTOR	17213847	YES		11/7/2018

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:	GREGORY AUTUORI
Title:	MANAGER
Phone Number:	3472547136
Email Address:	NAMELYBENEFITS@NAMELY.COM