Notification of Changes for Business Entity
General Information
Business Entity Name:	FINANCIAL INSURANCE SEVICES INC
Incorporation / Formation Date:
FEIN:	470791671
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	DOUGLAS
Business Address
Address 1:	5601 N 103RD ST
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
Phone:	4029632361
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	5601 N 103RD ST
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
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
HAYES, ANASTASIA	AGENT	1101762		YES	7/8/16
CAPSHAW, EBONY	AGENT	1101032		YES	7/8/16
PRUETT, JAIMI	AGENT	992194		YES	7/8/16
ADAMS, HEATHER	AGENT	1058931		YES	7/8/16
FISHEL, MYLES	AGENT	1099564		YES	7/8/16
SMITH, PATRICE	AGENT	1089770		YES	7/8/16
KLEIN, ASHLEY	AGENT	1011761		YES	7/8/16
MOTKO, JASON	AGENT	1067766		YES	7/8/16
JONES, CATHERINE	AGENT	1101784		YES	7/8/16
HELDERMAN, AMY	AGENT	1096978		YES	7/8/16

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:	JO WATERS
Title:	LICENSING SPECIALIST
Phone Number:	4029636973
Email Address:	JO.WATERS@SITEL.COM