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 NORTH 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 NORTH 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
DARRION CRIBBS	PRODUCER	18735640	YES		04/13/2018
JENNA CROOK	PRODUCER	18706988	YES		04/13/2018
SABRINA CRUZE	PRODUCER	18728313	YES		04/13/2018
JUSTICE CULLINS	PRODUCER	18723436	YES		04/13/2018
ZIBIAH CUNNINGHAM	PRODUCER	18629046	YES		04/13/2018
COURTNEY DAVIS	PRODUCER	18695795	YES		04/13/2018
AMBERLY DENNIS	PRODUCER	18678068	YES		04/13/2018
DEMARA EASLEY	PRODUCER	18722767	YES		04/13/2018
DOROTHY ELLIS	PRODUCER	11780167	YES		04/13/2018
ADRIAN FIELDS	PRODUCER	16257101	YES		04/13/2018
GRATESHA FITE	PRODUCER	17813805	YES		04/13/2018
MARY GARVIN	PRODUCER	18716811	YES		04/13/2018
DAVETTE GEDEON	PRODUCER	18742660	YES		04/13/2018
DIERA GORDON	PRODUCER	18675678	YES		04/13/2018
COURTNEY HARRISON	PRODUCER	18738033	YES		04/13/2018

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
BRENDEN HEWITT	PRODUCER	18717336	YES		04/13/2018

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:	KATHERINE VEENSTRA-REYES
Title:	LICENSING SPECIALIST
Phone Number:	4029632361
Email Address:	KATHERINE.REYES@SITEL.COM