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:	OH
County:	DOUGLAS
Business Address
Address 1:	5601 N 103RD ST
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
Phone:	4029632361
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	5601 N 103RD 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
ADAMS, RACHEL	AGENT	1091517		YES	6-1-16
ADCOCK, WILLIAM	AGENT	1063024		YES	6-1-16
BIVENS, BRANDI	AGENT	1099385		YES	6-1-16
CRAIG, LISA	AGENT	1096024		YES	6-1-16
DYER, AMBER	AGENT	1100957		YES	6-1-16
HARB, AMY	AGENT	1101813		YES	6-1-16
HERRIN, KAYLEE	AGENT	1075090		YES	6-1-16
LAWSON, JAMES	AGENT	1101414		YES	6-1-16
MINOR, VICTORIA	AGENT	1087919		YES	6-1-16
MOLINA, WINSTON	AGENT	1101756		YES	6-1-16
PIERCE, DEANNA	AGENT	1024154		YES	6-1-16
PYE SANON, KAREN	AGENT	1016536		YES	6-1-16
SHELTON, MICHELLE	AGENT	1063034		YES	6-1-16
SPENCER, ARISA	AGENT	1088484		YES	6-1-16
TEMPLIN, ZACKARY	AGENT	1097792		YES	6-1-16

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:	JO WATERS
Title:	LICENSING SPECIALIST
Phone Number:	4029636973
Email Address:	JO.WATERS@SITEL.COM