Notification of Changes for Business Entity
General Information
Business Entity Name:	TMS RE, INC.
Incorporation / Formation Date:
FEIN:	650644164
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	DE
County:	ESSEX
Business Address
Address 1:	200 BRICKSTONE SQUARE, SUITE 500
Address 2:
City:	ANDOVER
State:	MA
Zip:	01810
Phone:	786-747-0816
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	200 BRICKSTONE SQUARE, SUITE 500
Address 2:
City:	ANDOVER
State:	MA
Zip:	01810
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	MUNICH RE STOP LOSS, INC.
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
MICHAEL E. SHEVLIN	DIR, CHAIRMAN, CEO	125-48-7396	YES		09/27/18
TRAVIS J. MICUCCI	DIR, PRES, TREAS, COO	005-82-7784	YES		09/27/18
TERESA M. CHEUNG	DIRECTOR, SECRETARY	592-18-3696	YES		09/27/18

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:	TRAVIS J. MICUCCI
Title:	PRESIDENT
Phone Number:	786-747-0816
Email Address:	DSERRAO@MUNICHRE.COM