Notification of Changes for Business Entity
General Information
Business Entity Name:	CONVERGYS CMG INSURANCE SERVICES
Incorporation / Formation Date:
FEIN:	274587113
Ohio License Number:	42227
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	HAMILTON
Business Address
Address 1:	201 E. FOURTH STREET
Address 2:
City:	CINCINNATI
State:	OH
Zip:	45202
Phone:	5137237000
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	250 W. MAIN STREET
Address 2:	SUITE 2800
City:	LEXINGTON
State:	KY
Zip:	40507
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
ANDREW FARWIG	SECRETARY	208666245	YES		04/01/2018
TAMMY ROHRER	SECRETARY	281629537		YES	04/01/2018

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:	JAY HOLLEY
Title:	ASST COMPLIANCE OFFICE/DRP
Phone Number:	8592447543
Email Address:	JHOLLEY@FBTLAW.COM