Notification of Changes for Business Entity
General Information  
Business Entity Name: WELLS FARGO INSURANCE, INC.
Incorporation / Formation Date:  
FEIN: 410587845
Ohio License Number: 23765
NPN: 654461
DBA / Trade Name:  
State of Domicile: MN
County: HENNEPIN
Business Address  
Address 1: 550 S 4TH ST
Address 2:  
City: MINNEAPOLIS
State: MN
Zip: 55415
Phone: 612.667.3931
Fax:  
Business Web Site Address:  
Business Email Address: WFIILICENSING@WELLSFARGO.COM
Mailing Address  
Address 1: 550 S 4TH ST
Address 2:  
City: MINNEAPOLIS
State: MN
Zip: 55415
   
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
KIRA MESTNIK PRODUCER 17117028   YES 03/30/2018
TIMOTHY OLSEN PRODUCER 8767091   YES 03/30/2018
MATTHEW QVALE PRODUCER 8652783   YES 03/30/2018
ANNOI SAYACHACK PRODUCER 17630362   YES 03/30/2018
JODY SIPE PRODUCER 16877834   YES 03/30/2018
SUSAN WENKUS PRODUCER 372923   YES 03/30/2018
PATRICIA ZANGS PRODUCER 1052770   YES 03/30/2018
AZUCENA ZELAYA PRODUCER 17773419   YES 03/30/2018
           
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: SHARMAINE ECKARD
Title: LICENSING COORDINATOR
Phone Number: 612-667-3931
Email Address: SHARMAINE.ECKARD@WELLSFARGO.COM