Notification of Changes for Business Entity
General Information
Business Entity Name:	FUTURITY FIRST INSURANCE GROUP INC.
Incorporation / Formation Date:	01/04/2008
FEIN:	26-1553785
Ohio License Number:	37860
NPN:	10348037
DBA / Trade Name:
State of Domicile:	DE
County:	NEW CASTLE
Business Address
Address 1:	101 CENTERPOINT DR STE 208
Address 2:
City:	MIDDLETOWN
State:	CT
Zip:	06457
Phone:	402-343-3634
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	8420 W DODGE RD STE 510
Address 2:
City:	OMAHA
State:	NE
Zip:	68114
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
MICHAEL LYNN GALLAGHER	PRODUCER	2725423	YES		09/12/2018
GREG S LAVIN	PRODUCER	347414	YES		09/12/2018
GREGORY E GARNER	PRODUCER	70297	YES		09/12/2018
WILLIAM D VREELAND	PRODUCER	1639483	YES		09/12/2018
DAVID LEE VAUGHAN	PRODUCER	337691	YES		09/12/2018
SYED EJAZ MEHDY	PRODUCER	8734706	YES		09/12/2018
ABDUL RAHIM DADABHOY	PRODUCER	9456117	YES		09/12/2018
LELAND LI	PRODUCER	17098735	YES		09/12/2018
BRADLEY CHARLES PANOS	PRODUCER	8975411	YES		09/12/2018
JASON BRANDFORD WHITTIER	PRODUCER	17513848	YES		09/12/2018
JERRY A STURGILL	PRODUCER	1892612	YES		09/12/2018
JACEK SZPERNOGA	PRODUCER	17931089	YES		09/12/2018

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:	HERSHEL KLEINBERG
Title:	CHAIRMAN OF BOARD
Phone Number:	402-343-3634
Email Address:	CYNTHIA @SENIORMARKETSALES.COM