Notification of Changes for Business Entity
General Information
Business Entity Name:	COVERWALLET, INC
Incorporation / Formation Date:
FEIN:	475163925
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NY
County:	KINGS
Business Address
Address 1:	C/O TWO SIGMA INVESTMENTS, LLC 100 AVENUE OF THE AMERICAS 16
Address 2:
City:	NEW YORK
State:	NY
Zip:	10013
Phone:	585-509-9346
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	C/O TWO SIGMA INVESTMENTS, LLC 100 AVENUE OF THE AMERICAS 16
Address 2:
City:	NEW YORK
State:	NY
Zip:	10013
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
KEVIN LAMOY	PRODUCER	17788909	YES		8/20/2018
ROBERT LEONARD	PRODUCER	238695720	YES		8/20/2018
CALEB STACY	PRODUCER	094721505	YES		8/20/2018

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:	DELMIRA BUTLER
Title:	COMPLIANCE SPECIALIST
Phone Number:	2547296129
Email Address:	DBUTLER@ILSAINC.COM