Notification of Changes for Business Entity
General Information
Business Entity Name:	ANV GLOBAL SERVICES, INC.
Incorporation / Formation Date:
FEIN:	27-0340332
Ohio License Number:
NPN:	14612330
DBA / Trade Name:
State of Domicile:	NJ
County:	HUDSON
Business Address
Address 1:	200 HUDSON STREET
Address 2:	HARBORSIDE TWO, SUITE 800
City:	JERSEY CITY
State:	NJ
Zip:	07311
Phone:	860-571-3104
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	200 HUDSON STREET
Address 2:	HARBORSIDE TWO, SUITE 800
City:	JERSEY CITY
State:	NJ
Zip:	07311
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
JOSEPH COSTELLO	RDA	5698041	YES		08/27/2018
CHRISTOPHER FOY	RDA	3411655	YES		08/27/2018
STUART HOLLANDER	RDA	3393774		YES	08/27/2018

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
HARRY SCHLACHTER	TREASURER, DIRECTOR	074-50-6936	YES		08/27/2018
MICHAEL G. WOMACK	MANAGER, VICE PRESIDENT	27-0340332		YES	08/27/2018
MICHAEL G. WOMACK	DIRECTOR	27-0340332	YES		08/27/2018
STEPHEN UNGAR	SECRETARY, DIRECTOR	106-60-3542	YES		08/27/2018
MICHAEL SAXON	PRESIDENT	297-66-4885	YES		08/27/2018
DELYNN TRIVISON	VICE PRESIDENT	266-65-1847	YES		08/27/2018
JOSEPH COSTELLO	UNDERWRITING MANAGER	119-66-2636	YES		08/27/2018
BARRY MOSES	DIRECTOR	299-50-5624	YES		08/27/2018
STUART HOLLANDER	PRESIDENT	132-56-8251		YES	08/27/2018

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)
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:	COMPLIANCE SPECIALIST
Phone Number:	972-788-6811
Email Address:	PRODUCER.LICENSING@AMTRUSTGROUP.COM