Notification of Changes for Business Entity
General Information
Business Entity Name:	FINANCIAL INSURANCE SERVICES INC
Incorporation / Formation Date:
FEIN:	470791671
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	DE
County:	DOUGLAS
Business Address
Address 1:	5601 NORTH 103 ST
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
Phone:	4029632361
Fax:
Business Web Site Address:	SITEL
Business Email Address:	AGENT@SITEL.COM
Mailing Address
Address 1:	5601 NORTH 103 ST
Address 2:
City:	OMAHA
State:	OH
Zip:	68134
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
VICTORIA SANDS	AGENT	18201858	YES		12-03-2018
MICHAEL TEAGUE	AGENT	18965209	YES		12-03-2018
SHYDAEA TOWNES	AGENT	18965195	YES		12-03-2018
EBONIE AVANT	AGENT	18978017	YES		12-03-2018
KEISHANIQUE BROWN	AGENT	18966640	YES		12-03-2018
CHRISTOPHER CARD	AGENT	18969093	YES		12-03-2018
ROSEANNE DANCEL	AGENT	18815697	YES		12-03-2018
SHAPHON DAVIS	AGENT	18949453	YES		12-03-2018
KABREEYA DUDLEY	AGENT	18966704	YES		12-03-2018
TIMOTHY DUNGAR	AGENT	18971224	YES		12-03-2018
HOLLIE EVANS	AGENT	18971226	YES		12-03-2018
ONI FRANCISCO	AGENT	18971161	YES		12-03-2018
EMILY GONZALEZ	AGENT	18971192	YES		12-03-2018
TASHA GROHMAN	AGENT	18971232	YES		12-03-2018
COKILYA KEITH	AGENT	18966638	YES		12-03-2018

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:	SHARON WALKER
Title:	LICENSING SPECIALIST
Phone Number:	4029632361
Email Address:	AGENT@SITEL.COM