Notification of Changes for Business Entity
General Information
Business Entity Name:	AIG DIRECT INSURANCE SERVICES INC.
Incorporation / Formation Date:
FEIN:	330658270
Ohio License Number:	13444
NPN:
DBA / Trade Name:
State of Domicile:	CA
County:	SAN DIEGO
Business Address
Address 1:	9640 GRANITE RIDGE DR
Address 2:	STE 200
City:	SAN DIEGO
State:	CA
Zip:	92123
Phone:	858-309-3000
Fax:
Business Web Site Address:
Business Email Address:	LICENSING@AIGDIRECT.COM
Mailing Address
Address 1:	9640 GRANITE RIDGE DR
Address 2:	STE 200
City:	SAN DIEGO
State:	CA
Zip:	92123
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
JORGE IVAN MANCILLA	PRODUCER	18805380	YES		08/01/2018
WILLIAM MICHAEL PROPPER	PRODUCER	18670166	YES		08/01/2018

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:	CHRISTINA MILLER
Title:	SR LICENSING SPECIALIST
Phone Number:	858-309-3652
Email Address:	LICENSING@AIGDIRECT.COM