Notification of Changes for Business Entity
General Information
Business Entity Name:	AMERICA DIRECT INSURANCE AGENCY INC
Incorporation / Formation Date:	07/25/2006
FEIN:	20-3271576
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	IL
County:	COOK
Business Address
Address 1:	8700 W BRYN MAWR AVE
Address 2:	SUITE 900 S
City:	CHICAGO
State:	IL
Zip:	60631
Phone:	(312)379-2954
Fax:
Business Web Site Address:
Business Email Address:	FLASTATEFILE@FIDELITYLIFE.COM
Mailing Address
Address 1:	8700 W BRYN MAWR AVE
Address 2:	SUITE 900 S
City:	CHICAGO
State:	IL
Zip:	60631
Indicate the type of change you are seeking
Address Change:	YES
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

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:	ROBERT WORTH
Title:	SR STAFF ACCOUNTANT
Phone Number:	(312)379-2954
Email Address:	FLASTATEFILE@FIDELITYLIFE .COM