Notification of Changes for Business Entity
General Information
Business Entity Name:	FINANCIAL INSURANCE SERVICES INC
Incorporation / Formation Date:
FEIN:	47-0791671
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
MCCAULLEY, HAILEY	AGENT	18720626	YES		03/30/2018
MONTGOMERY, SARAH	AGENT	18425996	YES		03/30/2018
MOORE, ALEXIS	AGENT	18448992	YES		03/30/2018
MORGAN, KYNDAL	AGENT	18343931	YES		03/30/2018
ODELL, CAYLA	AGENT	18390639	YES		03/30/2018
OGLESBY, LEWIS	AGENT	6429227	YES		03/30/2018
PAINTER, ALICIA	AGENT	18456389	YES		03/30/2018
ROOKARD, ANTHONIE	AGENT	18712061	YES		03/30/2018
SANDERS, TIFFANY	AGENT	18444849	YES		03/30/2018
SCHIMELFANICK, KRISTIN	AGENT	18681531	YES		03/30/2018
SCRUGGS, DENISE	AGENT	18390607	YES		03/30/2018
SHERWIN, ANITA	AGENT	18390633	YES		03/30/2018
SITTON, KAMARA	AGENT	18292539	YES		03/30/2018
SIZEMORE, ASHLEY	AGENT	18164652	YES		03/30/2018
SMITH, CHASSITY	AGENT	18444834	YES		03/30/2018

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:	4029632361
Email Address:	AGENT@SITEL.COM