Notification of Changes for Business Entity
General Information
Business Entity Name:	ANDREINI & COMPANY OF OKLAHOMA, INC.
Incorporation / Formation Date:	12/13/2011
FEIN:	90-0783777
Ohio License Number:	957728
NPN:	16530908
DBA / Trade Name:
State of Domicile:	OK
County:	OKLAHOMA
Business Address
Address 1:	14101 WIRELESS WAY #350
Address 2:
City:	OKLAHOMA CITY
State:	OK
Zip:	73134
Phone:	(405) 840-4370
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	220 WEST 20TH AVENUE
Address 2:
City:	SAN MATEO
State:	CA
Zip:	94403
Indicate the type of change you are seeking
Address Change:	YES
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

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:	CYNTHIA INUMERABLE
Title:	LICENSING COORDINATOR
Phone Number:	650-378-4370
Email Address:	CINUMERABLE@ANDREINI.COM