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 N 103RD ST
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 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
SMITH, CORRINNE	AGENT	18688143	YES		04/02/2018
STOKES, BRIANNA	AGENT	18686904	YES		04/02/2018
THORNTON, CAMERON	AGENT	18680829	YES		04/02/2018
TROWELL, KAYLA	AGENT	18668744	YES		04/02/2018
WALKER, BRANDON	AGENT	18679471	YES		04/02/2018
WALLACE, NIA	AGENT	18679524	YES		04/02/2018
WALTOWER, IKEQUINTEZ	AGENT	18678174	YES		04/02/2018
WHITE, LACEY	AGENT	18692708	YES		04/02/2018
WILLIAMS, JAMILA	AGENT	18678184	YES		04/02/2018
WILSON, SONYA	AGENT	18695486	YES		04/02/2018
YOUNG, AMANDA	AGENT	18668741	YES		04/02/2018
ALDABET, JENNIFER	AGENT	16735857	YES		04/02/2018
ANDERSON, KRISTINE	AGENT	18662272	YES		04/02/2018
BARNETTE, REBECCA	AGENT	18699310	YES		04/02/2018
BISHOP, MISTY	AGENT	18665485	YES		04/02/2018

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:	STACY DEVAUGHAN
Title:	LICENSING SPECIALIST
Phone Number:	402-963-2361
Email Address:	AGENT@SITEL.COM