Notification of Changes for Business Entity
General Information
Business Entity Name:	LOCKTON AFFINITY, LLC
Incorporation / Formation Date:
FEIN:	48-1042261
Ohio License Number:	24925
NPN:	655503
DBA / Trade Name:
State of Domicile:	KS
County:	JOHNSON
Business Address
Address 1:	7300 COLLEGE BLVD SUITE 500
Address 2:
City:	OVERLAND PARK
State:	KS
Zip:	66210
Phone:	9136527500
Fax:
Business Web Site Address:
Business Email Address:	KCLICENSING@LOCKTON.COM
Mailing Address
Address 1:	7300 COLLEGE BLVD SUITE 500
Address 2:
City:	OVERLAND PARK
State:	KS
Zip:	66210
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
CLAUDIA MANDATO	EVP - OPERATIONS	946200	YES		12/13/2017
ALLEN COLLINS	AGENT	18496942	YES		12/13/2017
AMY SMITHER	AGENT	5074838	YES		12/13/2017
CHRISTOPHER FIELDS	AGENT	16888160	YES		12/13/2017
DEAN NORDHUS	AGENT	6110513	YES		12/13/2017
EBONEE BELL	AGENT	17833856	YES		12/13/2017
EDWARD BENTON	AGENT	2065185	YES		12/13/2017
HANNA MALONE	AGENT	10734618	YES		12/13/2017
KAREN NILSEN	AGENT	4873025	YES		12/13/2017
MIA TORIAN	AGENT	15750320	YES		12/13/2017
MICHAEL CLARK	AGENT	16363227	YES		12/13/2017
RODNEY WHITE	AGENT	17512062	YES		12/13/2017
SARAH WELCH	AGENT	17600089	YES		12/13/2017
SEAN PHIPPS	AGENT	17290484	YES		12/13/2017
STEVEN REDMOND	AGENT	16471708	YES		12/13/2017

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:	JEFFREY B HEWITT
Title:	VICE PRESIDENT
Phone Number:	9136527500
Email Address:	KCLICENSING@LOCKTON.COM