Notification of Changes for Business Entity
General Information
Business Entity Name:	NFS EDGE INSURANCE AGENCY, INC.
Incorporation / Formation Date:
FEIN:	200359075
Ohio License Number:	1129771
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	CLARK
Business Address
Address 1:	4 WEST MAIN STREET
Address 2:	SUITE 600
City:	SPRINGFIELD
State:	OH
Zip:	45502
Phone:	847-442-1876
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	4 OVERLOOK POINT
Address 2:
City:	LINCOLNSHIRE
State:	IL
Zip:	60069
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
PAMELA BEATRICE GERALD	EMPLOYEE	69689		YES	11/29/2016

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
PAMELA BEATRICE GERALD	RDA	69689		YES	11/29/2016
PAMELA BEATRICE GERALD	VICE PRESIDENT	69689		YES	11/29/2016

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:	KATHLEEN MESMER
Title:	LICENSING ADMINISTRATOR
Phone Number:	8474421876
Email Address:	AGENCY.LICENSING.MAILBOX@AON.COM