Notification of Changes for Business Entity
General Information
Business Entity Name:	GEICO INSURANCEW AGENCY, INC
Incorporation / Formation Date:
FEIN:	521168724
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	MD
County:	MONTGOMERY
Business Address
Address 1:	5260 WESTERN AVE
Address 2:
City:	FREDERICKSBURG
State:	VA
Zip:	20815
Phone:	540-286-7147
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1 GEICO BLVD
Address 2:	4TH FLOOR LICENSING
City:	FREDERICKSBURG
State:	VA
Zip:	22412
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
SAMANTHA BROWN	AGENT	18479343	YES		8/14/17

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:	KIMBERLY LINDSAY
Title:	DRLP
Phone Number:	540-286-7147
Email Address:	MOATLICENSING@GEICO.COM