Notification of Changes for Business Entity
General Information
Business Entity Name:	SELECTQUOTE INSURANCE SERVICES
Incorporation / Formation Date:
FEIN:	680027389
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	CA
County:	SAN FRANCISCO
Business Address
Address 1:	595 MARKET ST., 10TH FLOOR
Address 2:
City:	SAN FRANCISCO
State:	CA
Zip:	94105
Phone:	4155437338
Fax:
Business Web Site Address:
Business Email Address:	SPERRY@SELECTQUOTE.COM
Mailing Address
Address 1:	595 MARKET ST., 10TH FLOOR
Address 2:
City:	SAN FRANCISCO
State:	CA
Zip:	94105
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
ARVAUGHN JAMMAL BAKER	PRODUCER	18149934	YES		12/08/2016
JUSTIN FREDRIC CORRAL	PRODUCER	18164582	YES		12/08/2016
DONALD VINCENT HARAWAY III	PRODUCER	17775172	YES		12/08/2016
STEVEN CURTIS JINRIGHT	PRODUCER	7998058	YES		12/08/2016
SALE' MORONI KEY	PRODUCER	18171824	YES		12/08/2016
RICHARD HENRY LUCAS III	PRODUCER	18178856	YES		12/08/2016
ERIK REIN PAABO	PRODUCER	18161211	YES		12/08/2016
JONATHAN PHILLIP PEREIRA	PRODUCER	18207757	YES		12/08/2016
LAMONT RIVOT SHEPPARD	PRODUCER	17099033	YES		12/08/2016
JONATHAN WARD STANDIFORD	PRODUCER	3229852	YES		12/08/2016
SCOTT SINCLAIR WILKES, JR	PRODUCER	18174197	YES		12/08/2016
EDWIN JAMAL MASON	PRODUCER	2603757		YES	12/08/2016
ANDRE ALLEN SANTIAGO	PRODUCER	8033841		YES	12/08/2016

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:	CHARAN JIT SINGH
Title:	CEO
Phone Number:	4155437338
Email Address:	SPERRY@SELECTQUOTE.COM