Notification of Changes for Business Entity
General Information  
Business Entity Name: MML INSURANCE AGENCY, LLC
Incorporation / Formation Date:  
FEIN: 04-3109325
Ohio License Number:
NPN:
DBA / Trade Name:  
State of Domicile: MA
County: HAMPDEN
Business Address  
Address 1: 1295 STATE STREET
Address 2:  
City: SPRINGFIELD
State: MA
Zip: 01111
Phone: 800-767-1000
Fax:  
Business Web Site Address:  
Business Email Address:  
Mailing Address  
Address 1: 1295 STATE STREET
Address 2:  
City: SPRINGFIELD
State: MA
Zip: 01111
   
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
MICHEAL LYON PRODUCER 17598079 YES   11/2/2015
JUDITH D ANDREA PRODUCER 17275150 YES   11/2/2015
DANIEL CONNOR PRODUCER 16395406 YES   11/2/2015
JAMES CASH PRODUCER 2265286   YES 10/14/2015
RYAN FLYNN PRODUCER 16347093   YES 10/15/2015
KEVIN ROOD PRODUCER 967588   YES 10/28/2015
TIMOTHY VILLRATH PRODUCER 9135720   YES 11/2/2015
           
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: JOHN ROGAN
Title: AVP
Phone Number: 800-767-1000
Email Address: JROGAN@MASSMUTUAL.COM