Notification of Changes for Business Entity
General Information
Business Entity Name:	ALLEGIANS INS SERVICES
Incorporation / Formation Date:
FEIN:	32-0066635
Ohio License Number:	40940
NPN:	7652899
DBA / Trade Name:
State of Domicile:	OH
County:	COOK
Business Address
Address 1:	100 TOWER DRIVE, SUITE 120
Address 2:
City:	HINSDALE
State:	IL
Zip:	60527
Phone:	630-325-5600
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	100 TOWER DRIVE, SUITE 120
Address 2:
City:	HINSDALE
State:	IL
Zip:	60527
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
GREGORY CARTER	AGENT	7017620	YES		05/01/2016

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)	NO
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?	NO
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:	AMY GLENN
Title:	BROKERAGE ASSISTANT
Phone Number:	724-863-3420
Email Address:	L&C@AFGFS.COM