Notification of Changes for Business Entity
General Information
Business Entity Name:	ONPOINT UNDERWRITING, INC.
Incorporation / Formation Date:
FEIN:	20-8156019
Ohio License Number:	36507
NPN:
DBA / Trade Name:
State of Domicile:	GA
County:	FULTON
Business Address
Address 1:	SIX CONCOURSE PARKWAY STE 2300
Address 2:
City:	ATLANTA
State:	GA
Zip:	30328
Phone:	6786512200
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	SIX CONCOURSE PARKWAY STE 2300
Address 2:
City:	ATLANTA
State:	GA
Zip:	30328
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
ERIC HOMER	VICE PRESIDENT	535906417	YES		11/15/2018

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:	LISA STAHL
Title:	VICE PRESIDENT
Phone Number:	6196107170
Email Address:	LSTAHL@ARROWHEADGRP.COM