| Notification of Changes for Business Entity |
| General Information | |
| Business Entity Name: | AMERITAS INVESTMENT CORP. |
| Incorporation / Formation Date: | 12-29-83 |
| FEIN: | 47-0663374 |
| Ohio License Number: | 25178 |
| NPN: | 757746 |
| DBA / Trade Name: | 670609 |
| State of Domicile: | NE |
| County: | LANCASTER |
| Business Address | |
| Address 1: | 5900 O STREET |
| Address 2: | |
| City: | LINCOLN |
| State: | NE |
| Zip: | 68510 |
| Phone: | 402-467-6938 |
| Fax: | 402-467-6902 |
| Business Web Site Address: | HTTP://WWW.AMERITAS.COM |
| Business Email Address: | KSILVA@AMERITAS.COM |
| Mailing Address | |
| Address 1: | 5900 O STREET |
| Address 2: | |
| City: | LINCOLN |
| State: | NE |
| Zip: | 68510 |
| | |
| 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 |
| | |
| Members, Owners, Partners, Officers and Directors |
| Name | Title | Identifying # | Add | Delete | Eff. Date |
| KAROLYN K. CLINE | AVP, PUBLIC FINANCE | 522-08-4733 | | YES | 02-01-18 |
| JOHN M. HOLLAND | VP & MNGNG. DIR., PUB. FIN. | 511-56-4062 | | YES | 02-01-18 |
| JOHN S. JONES | AVP, PUBLIC FINANCE | 514-90-4170 | | YES | 02-01-18 |
| BRADFORD J. MAX | VP & MNGNG. DIR., PUB. FIN. | 510-62-2094 | | YES | 02-01-18 |
| JOHN C. MCARTHUR | VP, DIRECTOR, PUBLIC FINANCE | 515-54-6311 | | YES | 02-01-18 |
| MICHAEL L. SHORT | VP, DIRECTOR, PUBLIC FINANCE | 497-68-0815 | | YES | 02-01-18 |
| MATTHEW V. WEBSTER | VP, DIRECTOR, PUBLIC FINANCE | 364-62-5251 | | YES | 02-01-18 |
| DARLA G. WILTON | VP, CHIEF ADMIN. OFFICER | 458-19-4914 | | YES | 02-01-18 |
| 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 | |