Notification of Changes for Business Entity
General Information
Business Entity Name:	SBHU LIFE AGENCY, INC.
Incorporation / Formation Date:	03/14/1977
FEIN:	132896238
Ohio License Number:	38558
NPN:
DBA / Trade Name:
State of Domicile:	NY
County:	WESTCHESTER
Business Address
Address 1:	2000 WESTCHESTER AVENUE
Address 2:
City:	PURCHASE
State:	OH
Zip:	10577
Phone:	443-627-4934
Fax:	443-992-4225
Business Web Site Address:
Business Email Address:	SB_LICENSING@MORGANSTANLEY.COM
Mailing Address
Address 1:	1300 THAMES STREET
Address 2:	7TH FLOOR
City:	BALTIMORE
State:	MD
Zip:	21231
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
RANDY JAMES LANDRY	AGENT	4735200	YES		05/05/2016

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)
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:	JOSEPH TOLEDANO
Title:	VICE PRESIDENT
Phone Number:	443-627-4934
Email Address:	SB_LICENSING@MORGANSTANLEY.COM