Notification of Changes for Business Entity
General Information
Business Entity Name:	TZ INSURANCE, INC.
Incorporation / Formation Date:
FEIN:	271602268
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	BELGEN
Business Address
Address 1:	2200 FLETCHER AVE
Address 2:	4TH FLOOR
City:	FORT LEE
State:	NJ
Zip:	07024
Phone:	304-929-3257
Fax:	304-929-3259
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2200 FLETCHER AVE
Address 2:	4TH FLOOR
City:	FORT LEE
State:	NJ
Zip:	07024
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
ALEAH HOUGH	PRODUCER	17303671	YES		02/17/2016
BODUNRIN LADELE	PRODUCER	17268465	YES		02/17/2016
CARLA MUBANGA	PRODUCER	17338492	YES		02/17/2016
CHRISTOPHER HILSON GREENER	PRODUCER	16739542	YES		02/17/2016
CHRISTOPHER CARRINO	PRODUCER	8328950	YES		02/17/2016
CODY MULHALL	PRODUCER	11875477	YES		02/17/2016
DANIEL DAVIS	PRODUCER	8233013	YES		02/17/2016
JEREMY BELK	PRODUCER	17323758	YES		02/17/2016
LISA LANE	PRODUCER	16274032	YES		02/17/2016
MATTHEW WARING	PRODUCER	16661067	YES		02/17/2016
MEGAN MEIGE	PRODUCER	16203362	YES		02/17/2016
MICHELE SLAWON	PRODUCER	16893039	YES		02/17/2016
MICHELLE RIDGEWAY	PRODUCER	17067629	YES		02/17/2016
MUMHAMMAD BELL	PRODUCER	17041151	YES		02/17/2016
ROSS HARTSELL	PRODUCER	16827032	YES		02/17/2016

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:	MICHELE LEASURE
Title:	LICENSING SPECIALIST
Phone Number:	304-929-3257
Email Address:	LICENSING@TZINSURANCE.COM