Notification of Changes for Business Entity
General Information
Business Entity Name:	NERDWALLET INSURANCE SERVICES, INC.
Incorporation / Formation Date:
FEIN:	81-2498540
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	CA
County:	SAN FRANCISCO
Business Address
Address 1:	875 STEVENSON ST 5TH FL
Address 2:
City:	SAN FRANCISCO
State:	CA
Zip:	94103
Phone:	415-549-8913
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	875 STEVENSON ST 5TH FL
Address 2:
City:	SAN FRANCISCO
State:	CA
Zip:	94103
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
ROBERTJOCSON	EMPLOYEE	18836199	YES		07-14-2018

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:	KARI SMITH
Title:	LICENSING ADMINISTRATOR
Phone Number:	812-886-0191
Email Address:	KNSMITH@SUPPORTIVEIS.COM