Notification of Changes for Business Entity
General Information
Business Entity Name:	FINANCIAL INSURANCE SERVICES INC
Incorporation / Formation Date:
FEIN:	470791671
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NE
County:	DOUGLAS
Business Address
Address 1:	5601 N 103RD STREET
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
Phone:	4025169791
Fax:
Business Web Site Address:
Business Email Address:	AGENT@SITEL.COM
Mailing Address
Address 1:	5601 N 103RD STREET
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
KIERRA BAILEY	AGENT	18440968	YES		08/04/2017
LAWANDA BONAVENTURA	AGENT	18484140	YES		08/04/2017
VALERIE BLACK	AGENT	18424466	YES		08/04/2017
SANDRA BRANDT	AGENT	18472658	YES		08/04/2017
SAMUEL CRASS	AGENT	18472662	YES		08/04/2017
ALEXANDRA CRESPO	AGENT	18479416	YES		08/04/2017
CHARLES CULP	AGENT	16933385	YES		08/04/2017
SHARI DALTON	AGENT	18472656	YES		08/04/2017
MATTHEW DOMINICK	AGENT	18470449	YES		08/04/2017
CYRUS DUNLAP	AGENT	18470433	YES		08/04/2017
WILLIAM DES AUTELS	AGENT	16787675	YES		08/04/2017
JOSHUA EASTEP	AGENT	18449647	YES		08/04/2017
JOSHUA FALZARANO	AGENT	18451013	YES		08/04/2017
GIOVANNI GOMEZ	AGENT	18470444	YES		08/04/2017
TISHARA GRANT-SAXTON	AGENT	18442159	YES		08/04/2017

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)	NO
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?	NO
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:	CODI BOWMAN
Title:	LICENSING SPECIALIST
Phone Number:	4025169791
Email Address:	AGENT@SITEL.COM