| Notification of Changes for Business Entity |
| General Information | |
| Business Entity Name: | TRAVEL GUARD GROUP INC |
| Incorporation / Formation Date: | 5/3/1994 |
| FEIN: | 391788198 |
| Ohio License Number: | 24334 |
| NPN: | 766344 |
| DBA / Trade Name: | |
| State of Domicile: | WI |
| County: | PORTAGE |
| Business Address | |
| Address 1: | 3300 BUSINESS PARK DRIVE |
| Address 2: | |
| City: | STEVENS POINT |
| State: | WI |
| Zip: | 54482 |
| Phone: | 7152955977 |
| Fax: | 7152959370 |
| Business Web Site Address: | |
| Business Email Address: | CORPORATELICENSING@AIG.COM |
| Mailing Address | |
| Address 1: | 3300 BUSINESS PARK DRIVE |
| Address 2: | |
| City: | STEVENS POINT |
| State: | WI |
| Zip: | 54482 |
| | |
| 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: | NO |
| | |
| Licensed Producers |
| Name | Title | NPN | Add | Delete | Eff. Date |
| PHILLIP CLARK ANDRESSOHN | CALL CENTER REPRESENTATIVE | 18495087 | YES | | 11/2/2017 |
| ALIECA FERN BAILEY | CALL CENTER REPRESENTATIVE | 18472984 | YES | | 11/2/2017 |
| DWAYNE ANTHONY BEMBENEK | CALL CENTER REPRESENTATIVE | 18472966 | YES | | 11/2/2017 |
| CAITLYN CHRISTINE GOLLATA | CALL CENTER REPRESENTATIVE | 18495216 | YES | | 11/2/2017 |
| DYLAN MARTIN GULLICKSON | CALL CENTER REPRESENTATIVE | 18517473 | YES | | 11/2/2017 |
| JAMES PATRICK MAHER | CALL CENTER REPRESENTATIVE | 18517574 | YES | | 11/2/2017 |
| CHRISTINA MICHELLE STEINKE | CALL CENTER REPRESENTATIVE | 18494906 | YES | | 11/2/2017 |
| JEAN MARIE POLKOSKI | CALL CENTER REPRESENTATIVE | 18517529 | YES | | 11/2/2017 |
| | | | | | |
| 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 | |