Notification of Changes for Business Entity
General Information
Business Entity Name:	WORLD FINANCIAL GROUP INSURANCE AGENCY
Incorporation / Formation Date:
FEIN:	95-3809372
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	CA
County:	ORANGE
Business Address
Address 1:	145 SOUTH STATE COLLEGE
Address 2:	SUITE 115-G
City:	BREA
State:	CA
Zip:	92821
Phone:	7704539300
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	11315 JOHNS CREEK PARKWAY
Address 2:
City:	DULUTH
State:	GA
Zip:	30097
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
ASHLEY TINA HARRIS	AGENT	1146907	YES		6/5/2017

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:	STEPHANIE HOSIER
Title:	DIRECTOR OF LICENSING
Phone Number:	7704539300
Email Address:	PATRICIA.JONES@TRANSAMERICA.COM