Notification of Changes for Business Entity
General Information
Business Entity Name:	NATIONAL TEACHER ASSOCIATES, INC
Incorporation / Formation Date:	10/26/1993
FEIN:	75-2508258
Ohio License Number:	1089030
NPN:	1623165
DBA / Trade Name:
State of Domicile:	DE
County:	KENT
Business Address
Address 1:	1675 SOUTH STATE STREET STE B
Address 2:
City:	DOVER
State:	DE
Zip:	19901
Phone:	9725322146
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1675 SOUTH STATE STREET STE B
Address 2:
City:	DOVER
State:	DE
Zip:	19901
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
BLAKELY, DEIDRA	PRODUCER	1780653	YES		08/01/2016
CUDDEBACK, ROBERT	PRODUCER	2390611	YES		08/01/2016
HOLLIDAY, RICHARD	PRODUCER	9192467	YES		08/01/2016
MINNICK, MATTHEW	PRODUCER	7328181	YES		08/01/2016
WALCOTT, MARK	PRODUCER	15343520	YES		08/01/2016
WALCOTT, MAXWELL	PRODUCER	17053765	YES		08/01/2016

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)
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?
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:	BRIAN ELLARD
Title:	DIRECTOR
Phone Number:	972-532-2146
Email Address:	BEVERLY.NABORS@NTALIFE.COM