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 NORTH 103 ST
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
Phone:	4029632361
Fax:
Business Web Site Address:	SITEL
Business Email Address:	AGENT@SITEL.COM
Mailing Address
Address 1:	5601 NORTH 103 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
JENNIFER MILLER	AGENT	18978682	YES		12-13-2018
WALKER MOCK	AGENT	18978661	YES		12-13-2018
RONNA SIMKINS	AGENT	7439359	YES		12-13-2018
NOLAN VANCE	AGENT	18979484	YES		12-13-2018
TRENYLA BREWER	AGENT	18979038	YES		12-13-2018
JESSICA BRINK	AGENT	18979043	YES		12-13-2018
ROSELYN BROWN	AGENT	18979034	YES		12-13-2018
TILMAN NORTON	AGENT	18980658	YES		12-13-2018
SHAREDA RUFFIN	AGENT	18980617	YES		12-13-2018
JUSTIN TAYLOR	AGENT	18980663	YES		12-13-2018
KDRIANNA WADE	AGENT	18980662	YES		12-13-2018
DAMIAN ALFARO	AGENT	18982602	YES		12-13-2018
ALEXANDRIA BROWN	AGENT	18982779	YES		12-13-2018
MICHAEL BRYANT	AGENT	18982774	YES		12-13-2018
CARLOS GONALEZ	AGENT	18983828	YES		12-13-2018

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:	SHARON WALKER
Title:	LICENSING SPECIALIST
Phone Number:	4029632361
Email Address:	AGENT@SITEL.COM