Notification of Changes for Business Entity
General Information
Business Entity Name:	NATIONAL TEACHER ASSOCIATES, INC
Incorporation / Formation Date:
FEIN:	752508258
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	DE
County:	KENT
Business Address
Address 1:	1675 SOUTH STATE STREET STE B
Address 2:
City:	DOVER
State:	DE
Zip:	19901
Phone:	9725322146
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1675 SOUTH STATE STREET STE B
Address 2:
City:	DOVER
State:	DE
Zip:	19901
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
ELLASON, RAYMOND	PRODUCER	1275759	YES		10/31/2016
LYNCH, MARK	PRODUCER	17764132	YES		10/31/2016
MCMULLEN, LAQUANNA	PRODUCER	16909424	YES		10/31/2016
MCMULLIN, SARA	PRODUCER	7960230	YES		10/31/2016
RAUM, CLIFFORD	PRODUCER	17867454	YES		10/31/2016
RICHARDS, VINCENT	PRODUCER	8112563	YES		10/31/2016
TROJACEK, CRAIG	PRODUCER	16301516	YES		10/31/2016

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:	BRIAN ELLARD
Title:	DIRECTOR
Phone Number:	9725322146
Email Address:	BEVERLY. NABORS@NTALIFE.COM