Notification of Changes for Business Entity
General Information
Business Entity Name:	FIRST NONPROFIT INSURANCE AGENCY INC
Incorporation / Formation Date:
FEIN:	36-3444822
Ohio License Number:	30304
NPN:	654369
DBA / Trade Name:
State of Domicile:	IL
County:	COOK
Business Address
Address 1:	233 N MICHIGAN AVE
Address 2:	SUITE 1000
City:	CHICAGO
State:	IL
Zip:	60601
Phone:	312-715-3010
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	400 EXECUTIVE BLVD
Address 2:	4TH FLOOR
City:	SOUTHINGTON
State:	CT
Zip:	06489
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:	CATHY KIMMEY
Title:	LICENSING SPECIALIST
Phone Number:	972-788-6811
Email Address:	PRODUCER.LICENSING@AMTRUSTGROUP.COM