Notification of Changes for Business Entity
General Information
Business Entity Name:	FUTURITY FIRST INSURANCE GROUP INC.
Incorporation / Formation Date:
FEIN:	26-1553785
Ohio License Number:
NPN:
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
JUSTIN WAYNE DAVIS	PRODUCER	8493695		YES	05/01/2018
JUDY MCCULLOUGH	PRODUCER	7749464		YES	05/01/2018
LESLIE J PAYNE	PRODUCER	10038966		YES	05/01/2018
BEVERLIE ELISABETH LEE	PRODUCER	17739152		YES	05/01/2018
ALI R EMAMI	PRODUCER	7650680		YES	05/01/2018
DANA CATHERINE HANNAH	PRODUCER	8450374		YES	05/01/2018
ADAM ALEXIS VELASCO	PRODUCER	17663837	YES		05/04/2018
SHABBIR FAZLE RAMZAN	PRODUCER	18299697	YES		05/04/2018
CHRISTOPHER P O'CONNELL	PRODUCER	780447	YES		05/04/2018
RANDY SCOTT GRUBE	PRODUCER	10499389	YES		05/04/2018
CARIN ROBERTA WHITEHURST	PRODUCER	6740491	YES		05/04/2018
SABRINA M CONAGE	PRODUCER	17097806	YES		05/04/2018
SHERYL LYNN SISLER MOORE	PRODUCER	1026105	YES		05/04/2018
MICHAEL J MATTA	PRODUCER	25390	YES		05/04/2018
NEIL D CHONOFSKY	PRODUCER	1429160	YES		05/04/2018

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