Notification of Changes for Business Entity
General Information
Business Entity Name:	TRANSAMERICA RETIREMENT INSURANCE AGENCY
Incorporation / Formation Date:
FEIN:	462720367
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	NEW CASTLE
Business Address
Address 1:	1209 ORANGE ST
Address 2:
City:	WILMINGTON
State:	DE
Zip:	19801
Phone:	6512864700
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	408 ST PETER STREET
Address 2:	SUITE 230
City:	ST PAUL
State:	MN
Zip:	55102
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
BYRON BLAINE	PRODUCER	8190876		YES	03/29/2016

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:	YOLANDA GARCIA
Title:	MANAGER
Phone Number:	213-742-2252
Email Address:	YOLANDA.GARCIA@TRANSAMERICA.COM