Notification of Changes for Business Entity
General Information
Business Entity Name:	BROOKLIGHT PLACE SECURITIES, INC.
Incorporation / Formation Date:
FEIN:	36-3317130
Ohio License Number:	25187
NPN:	38501
DBA / Trade Name:
State of Domicile:	OH
County:	DUPAGE
Business Address
Address 1:	1901 BUTTERFIELD ROAD, SUITE 220
Address 2:
City:	DOWNERS GROVE
State:	IL
Zip:	60515
Phone:	888-976-0659
Fax:	630-908-4741
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1901 BUTTERFIELD ROAD, SUITE 220
Address 2:
City:	DOWNERS GROVE
State:	IL
Zip:	60515
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:	AMY BUIKEMA
Title:	CCO, VICE-PRESIDENT
Phone Number:	888-976-0659
Email Address:	ABUIKEMA@BPSECINC.COM