Notification of Changes for Business Entity
General Information
Business Entity Name:	WNC INS SERVICES INC
Incorporation / Formation Date:
FEIN:	95-2956941
Ohio License Number:	28149
NPN:	963583
DBA / Trade Name:
State of Domicile:	CA
County:	LOS ANGELES
Business Address
Address 1:	899 EL CENTRO STREET
Address 2:
City:	SOUTH PASADENA
State:	CA
Zip:	91030
Phone:	6264636400
Fax:	6264632121
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	899 EL CENTRO STREET
Address 2:
City:	SOUTH PASADENA
State:	CA
Zip:	91030
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
JOHN P DECKER	DIRECTOR	368-36-9359		YES	12/10/2015

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:	LINDA LONG
Title:	CHIEF OPERATING OFFICER
Phone Number:	6264636432
Email Address:	AGENCYLICENSING@WNCFIRST.COM