Notification of Changes for Business Entity
General Information
Business Entity Name:	INSURANCE APPLICATIONS GROUP, INC.
Incorporation / Formation Date:
FEIN:	571117048
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	SC
County:	GREENVILLE
Business Address
Address 1:	220 N. MAIN STREET, SUITE 605
Address 2:
City:	GREENVILLE
State:	SC
Zip:	29601
Phone:	8645270474
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	220 N. MAIN STREET, SUITE 605
Address 2:
City:	GREENVILLE
State:	SC
Zip:	29602
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
NANCY ACTON	BUSINESS DEVELOPMENT EXECUTIVE	16939372	YES		5/19/2017

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:	CHRISTINE DEWITT
Title:	ACCOUNTING CLERK
Phone Number:	5016648044
Email Address:	CDEWITT@CENTRALLICENSINGBUREAU.COM