Notification of Changes for Business Entity
General Information
Business Entity Name:	FINANCIAL INSURANCE SERVICES INC
Incorporation / Formation Date:
FEIN:	470791671
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	DOUGLAS
Business Address
Address 1:	5601 N 103RD ST
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
Phone:	4029632361
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	5601 N 103RD ST
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
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
ANDERSON, TAYLOR	AGENT	17573131		YES	4-12-17
KIRBY, AUSTAN	AGENT	18096489		YES	4-12-17
MUHAMMAD, FAATIMAH	AGENT	17936389		YES	4-12-17
COX, AMY	AGENT	5956836		YES	4-12-17
MILLER, EMILY	AGENT	17031175		YES	4-12-17
GUM, CHRISTOPHER	AGENT	18032087		YES	4-12-17
SANDERS, ALICIA	AGENT	18104034		YES	4-12-17
KAUFMAN, JAKE	AGENT	18250693		YES	4-12-17
MCRAE, WILMA	AGENT	17413296	YES		4-12-17
DEVLUGT, DELICIA	AGENT	18369118	YES		4-12-17
GONZALES, MARGARET	AGENT	18369115	YES		4-12-17
HENDRIX, TINA	AGENT	18369107	YES		4-12-17

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:	JO WATERS
Title:	LICENSING SPECIALIST
Phone Number:	4029636973
Email Address:	JO.WATERS@SITEL.COM