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:	OH
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
LINDSAY, BRITTANY	AGENT	18057323	YES		9/14/16
LOFTIS, BAYLEE	AGENT	18062830	YES		9/14/16
MAGLOIRE, GAYLE	AGENT	18035434	YES		9/14/16
NESBITT, CLARISSA	AGENT	17996117	YES		9/14/16
NEVES, KELSEY	AGENT	18078250	YES		9/14/16
ODER, THOMAS	AGENT	18035447	YES		9/14/16
ORTIZ, SABRINA	AGENT	18078308	YES		9/14/16
PARHAM, JAHNE	AGENT	18062849	YES		9/14/16
RAINES, ASHLEY	AGENT	18035442	YES		9/14/16
RECTOR, EVA	AGENT	17996145	YES		9/14/16
RIVAN, ANDREW	AGENT	18090843	YES		9/14/16
RIVERS, BRANDON	AGENT	18055363	YES		9/14/16
SCHULTZ, SHELLY	AGENT	18062832	YES		9/14/16
SMITH, TIFFANY	AGENT	18039614	YES		9/14/16
SPRINGER, MICHAEL	AGENT	18035444	YES		9/14/16

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:	JO WATERS
Title:	LICENSING SPECIALIST
Phone Number:	4029636973
Email Address:	JO.WATERS@SITEL.COM