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:	NE
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:	NE
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
LAKENDRA ANDERSON	AGENT	18979460	YES		12-13-2018
KIA BATES	AGENT	18981241	YES		12-13-2018
JONATHON BECK	AGENT	18979461	YES		12-13-2018
WILLIAM BURCH	AGENT	11971648	YES		12-13-2018
CANDICE CROSBY	AGENT	18626002	YES		12-13-2018
KEYANNA DEWBERRY	AGENT	18979879	YES		12-13-2018
MELISSA HART	AGENT	18982209	YES		12-13-2018
CHRISTINA KING	AGENT	18982200	YES		12-13-2018
CHANEL MCDANIEL	AGENT	18982260	YES		12-13-2018
ALEXANDER MORROW	AGENT	18982284	YES		12-13-2018
TANIKA MOTON	AGENT	18982318	YES		12-13-2018
CARRIE ROBERTS	AGENT	18430550	YES		12-13-2018
BARBARA BARNETT	AGENT	17692470	YES		12-13-2018
KARI ELLIOTT	AGENT	16793175	YES		12-13-2018
MICHAEL MCCOY	AGENT	18978689	YES		12-13-2018

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