Notification of Changes for Business Entity
General Information
Business Entity Name:	NO EXAM LIFE INS INC
Incorporation / Formation Date:
FEIN:	463539354
Ohio License Number:	1130338
NPN:
DBA / Trade Name:
State of Domicile:	GA
County:	FULTON
Business Address
Address 1:	665 OAKSTONE DRIVE
Address 2:
City:	ROSWELL
State:	GA
Zip:	30075
Phone:	6785201809
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	665 OAKSTONE DRIVE
Address 2:
City:	ROSWELL
State:	GA
Zip:	30075
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:	JONATHAN FRITZ
Title:	PRESIDENT
Phone Number:	678-520-1809
Email Address:	JRFRITZ7@GMAIL.COM