Notification of Changes for Business Entity
General Information
Business Entity Name:	SELECTQUOTE INSURANCE SERVICES
Incorporation / Formation Date:
FEIN:	680027389
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	CA
County:	SAN FRANCISCO
Business Address
Address 1:	595 MARKET ST., 10TH FLOOR
Address 2:
City:	SAN FRANCISCO
State:	CA
Zip:	94105
Phone:	4155437338
Fax:
Business Web Site Address:
Business Email Address:	SPERRY@SELECTQUOTE.COM
Mailing Address
Address 1:	595 MARKET ST., 10TH FLOOR
Address 2:
City:	SAN FRANCISCO
State:	CA
Zip:	94105
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
TERRA NICOLE MAY	PRODUCER	18026202	YES		02/22/2017
MILES BRADLEY MOORE	PRODUCER	15824617	YES		02/22/2017
VINCENT CRAIG ROBERTS	PRODUCER	17769035	YES		02/22/2017

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)
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:	CHARAN JIT SINGH
Title:	CEO
Phone Number:	4155437338
Email Address:	SPERRY@SELECTQUOTE.COM