Notification of Changes for Business Entity
General Information
Business Entity Name:	UBS FINANCIAL SERVICES INSURANCE AGENCY INC.
Incorporation / Formation Date:	02/01/2017
FEIN:	51-0120742
Ohio License Number:	32809
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	USA
Business Address
Address 1:	1501 K. STREET NW
Address 2:	SUITE: 1100
City:	WASHINGTON
State:	DC
Zip:	20005
Phone:	201-352-9584
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1501 K. STREET NW
Address 2:	SUITE: 1100
City:	WASHINGTON
State:	DC
Zip:	20005
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
HOLIDAE H. HAYES	FINANCIAL ADVISOR	1136836	YES		02/01/2017
PATRICK D. THOMPSON	FINANCIAL ADVISOR	1136800	YES		02/01/2017
WILLIAM K. ZORR	FINANCIAL ADVISOR	1136886	YES		02/01/2017

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)	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:	TANYA HARRISON
Title:	COMPLIANCE OFFICER
Phone Number:	201-352-9584
Email Address:	TANYA.HARRISON@UBS.COM