Notification of Changes for Business Entity
General Information
Business Entity Name:	SUTHERLAND GLOBAL SERVICES INC
Incorporation / Formation Date:
FEIN:	16 - 1287080
Ohio License Number:	32628
NPN:	8372079
DBA / Trade Name:
State of Domicile:	VA
County:	CHESAPEAKE
Business Address
Address 1:	1313 EXECUTIVE BLVD
Address 2:
City:	CHESAPEAKE
State:	VA
Zip:	23320
Phone:	8667748570
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	SUTHERLAND GLOBAL SERVICES INC
Address 2:	1313 EXECUTIVE BLVD
City:	CHESAPEAKE
State:	VA
Zip:	23320
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
TIFFANY ABREU	PRODUCER	16697759	YES		04/05/2017

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:	BARBARA MOULTON
Title:	LICENSING ADMIN
Phone Number:	8667748570
Email Address:	SGSINSLIC@SUTHERLANDGLOBAL.COM