Notification of Changes for Business Entity
General Information
Business Entity Name:	MOGIL ORGANIZATION LLC
Incorporation / Formation Date:
FEIN:	274271208
Ohio License Number:	42507
NPN:	16184910
DBA / Trade Name:
State of Domicile:	NY
County:	NEW YORK
Business Address
Address 1:	116 EAST 27TH STREET
Address 2:
City:	NEW YORK
State:	NY
Zip:	10016
Phone:	2122527100
Fax:	2122528501
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	116 EAST 27TH STREET
Address 2:
City:	NEW YORK
State:	NY
Zip:	10016
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
ROBERT MOGIL	PRESIDENT	129508830	YES		01/10/2017
JEFFREY MOGIL	CEO	129508765	YES		01/10/2017
STEVEN LEVINE	EXECUTIVE VP	225787122	YES		08/28/1966

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:	CHRISTY KRICK
Title:	LICENSING ADMINISTRATOR
Phone Number:	8124942472
Email Address:	CKRICK@SUPPORTIVEIS.COM