Notification of Changes for Business Entity
General Information
Business Entity Name:	AIRWAYS INTERNATIONAL INSURANCE SERVICES LLC
Incorporation / Formation Date:
FEIN:	26-4617004
Ohio License Number:	40345
NPN:	13966309
DBA / Trade Name:
State of Domicile:	NJ
County:	GLOUCESTER
Business Address
Address 1:	401 HARMONY RD., STE.8
Address 2:
City:	GIBBSTOWN
State:	NJ
Zip:	08027
Phone:	856-423-4520
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 100
Address 2:
City:	MICKLETON
State:	NJ
Zip:	08056
Indicate the type of change you are seeking
Address Change:	YES
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

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:	ALEXANDER MORRIS
Title:	MANAGING MEMBER
Phone Number:	856-423-4520
Email Address:	AMORRIS@AIRWAYSINS.COM