Notification of Changes for Business Entity
General Information
Business Entity Name:	INSTANT INS AGENCY INC
Incorporation / Formation Date:	10/05/1998
FEIN:	752785328
Ohio License Number:	25082
NPN:
DBA / Trade Name:
State of Domicile:	TX
County:	DALLAS
Business Address
Address 1:	4500 FULLER DR STE 400
Address 2:
City:	IRVING
State:	TX
Zip:	75038
Phone:	7142522544
Fax:	7142522544
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	7711 CENTER AVE STE 200
Address 2:
City:	HUNTINGTON BEACH
State:	CA
Zip:	92647
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
MICHAEL KAPLAN	CFO	189-56-0301	YES		09/19/2017

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:	LAUREN MOORE
Title:	RDA
Phone Number:	9728273611
Email Address:	LAUREN.MOORE@AGGRESSIVEUSA.COM