Notification of Changes for Business Entity
General Information
Business Entity Name:	FINANCIAL INSURANCE SERVICES INC.
Incorporation / Formation Date:	08/01/1995
FEIN:	47-079-1671
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NE
County:	DOUGLAS
Business Address
Address 1:	5601 N 103RD STREET
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
Phone:	4029632361
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	5601 N 103RD STREET
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
WILLIAM HARMAN	AGENT	17949366	YES		07/12/2016
SARAH HAYENGA	AGENT	17910547	YES		07/12/2016
MICHAEL HELTON II	AGENT	17971204	YES		07/12/2016
DIANA HULING	AGENT	17922141	YES		07/12/2016
ELISHA IRICK	AGENT	17971234	YES		07/12/2016
JENNIFER JOHNSON	AGENT	17937897	YES		07/12/2016
TAYLOR JOHNSON	AGENT	17971240	YES		07/12/2016
MARC KEIRN	AGENT	17937675	YES		07/12/2016
NORMA KING	AGENT	17926284	YES		07/12/2016
DANIEL KREHER	AGENT	17977469	YES		07/12/2016
AUSTIN LAFFERTY	AGENT	17971242	YES		07/12/2016
KELVIN LEWIS	AGENT	17775365	YES		07/12/2016
AMANDA LONG	AGENT	17971192	YES		07/12/2016
NATHAN MARTIN	AGENT	17950718	YES		07/12/2016
ROBERT MONTGOMERY	AGENT	17950692	YES		07/12/2016

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)	NO
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?	NO
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:	CODI BOWMAN
Title:	LICENSING SPECIALIST
Phone Number:	4029632361
Email Address:	AGENT@SITEL.COM