Notification of Changes for Business Entity
General Information
Business Entity Name:	AAA CLUB ALLIANCE INC
Incorporation / Formation Date:
FEIN:	230758010
Ohio License Number:	951394
NPN:	7089389
DBA / Trade Name:
State of Domicile:	OH
County:	HAMILTON
Business Address
Address 1:	15 WEST CENTRAL PARKWAY
Address 2:
City:	CINCINNATI
State:	OH
Zip:	45202
Phone:	513-762-3379
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	15 WEST CENTRAL PARKWAY
Address 2:
City:	CINCINNATI
State:	OH
Zip:	45202
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	AAA ALLIED GROUP 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:	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:	SHAWNA SPURDLE
Title:	AUTHORIZED SUBMITTER
Phone Number:	8009279800
Email Address:	BLINSURANCE@CSCGLOBAL.COM