Notification of Changes for Business Entity
General Information
Business Entity Name:	MORGAN STANLEY INSURANCE SERVICES, INC.
Incorporation / Formation Date:	09/15/1972
FEIN:	510116113
Ohio License Number:	35488
NPN:
DBA / Trade Name:
State of Domicile:	DE
County:	NEW CASTLE
Business Address
Address 1:	1209 MARKET STREET
Address 2:
City:	WILMINGTON
State:	DE
Zip:	19801
Phone:	443-627-4934
Fax:	443-451-8218
Business Web Site Address:
Business Email Address:	SB_LICENSING@MORGANSTANLEY.COM
Mailing Address
Address 1:	1300 THAMES STREET
Address 2:	7TH FLOOR
City:	BALTIMORE
State:	MD
Zip:	21231
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
THOMAS HAYES	PRODUCER	16259559	YES		12/1/2015
ANTHONY DERTOUZOS	PRODUCER	958888	YES		12/1/2015
JOHN MORENO	PRODUCER	959133	YES		12/1/2015

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:	HANY YOUNIS
Title:	VICE PRESIDENT
Phone Number:	443-627-4934
Email Address:	SB_LICENSING@MORGANSTANLEY.COM