Notification of Changes for Business Entity
General Information
Business Entity Name:	TRANSAMERICA RETIREMENT INSURANCE AGENCY LLC
Incorporation / Formation Date:
FEIN:	46-2720367
Ohio License Number:	998053
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	NEW CASTLE
Business Address
Address 1:	1209 ORANGE STREET
Address 2:
City:	WILMINGTON
State:	DE
Zip:	19801
Phone:	6512864700
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	408 ST. PETER STREET, SUITE 230
Address 2:
City:	ST. PAUL
State:	MN
Zip:	55102
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
SAMUEL ANDREWS	INSURANCE PRODUCER	17231775	YES		5/1/2018

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)	NO
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?	NO
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:	JACKIE BUCHHOLZ
Title:	LEAD LICENSING SPECIALIST
Phone Number:	651-286-4743
Email Address:	JACKIE.BUCHHOLZ@TRANSAMERICA.COM