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:	NE
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
NORTH, IDA	AGENT	18629034	YES		04/02/2018
OCHOA, STEPHANIE	AGENT	18661389	YES		04/02/2018
OJEDA, COURTNEE	AGENT	18679474	YES		04/02/2018
OJEDA JR, MARTIN	AGENT	18667426	YES		04/02/2018
OROZCO, MICHELLE	AGENT	18689458	YES		04/02/2018
RAMOS, ANGELA	AGENT	18661385	YES		04/02/2018
SCOTT, ALLIYAH	AGENT	18696849	YES		04/02/2018
SIMPSON, MONIA	AGENT	18682208	YES		04/02/2018
SMITH, CHERILYNN	AGENT	18672871	YES		04/02/2018
SOTO, KEEGAN	AGENT	18649868	YES		04/02/2018
TALIAOA, MEAFUA	AGENT	18649995	YES		04/02/2018
TRAYLOR-SMITH, ROBYN	AGENT	18675345	YES		04/02/2018
VAN RIPER, KYLA	AGENT	18686816	YES		04/02/2018
VAZQUEZ, GIOVANNI	AGENT	18649979	YES		04/02/2018
WARREN, COURTNEY	AGENT	18677094	YES		04/02/2018

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)
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:	STACY DEVAUGHAN
Title:	LICENSE SPECIALIST
Phone Number:	4029632361
Email Address:	AGENT@SITEL.COM