Notification of Changes for Business Entity
General Information
Business Entity Name:	FINANCIAL INSURANCE SERVICE 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
JAQUEZ, JAZMIN	AGENT	18685413	YES		04/02/2018
JONES, TYLER	AGENT	18631705	YES		04/02/2018
KEY, TOCCARA	AGENT	18684024	YES		04/02/2018
MCDANIEL, ANDREW	AGENT	18630476	YES		04/02/2018
MOORE, KABREEA	AGENT	18629078	YES		04/02/2018
PATTON, SHAKEENA	AGENT	18652645	YES		04/02/2018
PATTON, SHERYL	AGENT	18629110	YES		04/02/2018
PHILLIPS, DIANNA	AGENT	18652648	YES		04/02/2018
RAYFORD, DANIELLE	AGENT	18629077	YES		04/02/2018
RICH, FERRIS	AGENT	18629084	YES		04/02/2018
SMITH, BRANDILYN	AGENT	18631710	YES		04/02/2018
SPAIN, ALICIA	AGENT	18631711	YES		04/02/2018
STEPHENSON, TRACIE	AGENT	18631707	YES		04/02/2018
SUBER, VICTORIA	AGENT	18631704	YES		04/02/2018
SYKES, AMANDA	AGENT	18111810	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:	4029632361
Email Address:	AGENT@SITEL.COM