Notification of Changes for Business Entity
General Information
Business Entity Name:	TZ INSURANCE SOLUTIONS LLC
Incorporation / Formation Date:
FEIN:	271602268
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NJ
County:	BELGEN
Business Address
Address 1:	2200 FLETCHER AVE 4TH FLOOR
Address 2:
City:	FORT LEE
State:	NJ
Zip:	07024
Phone:	3049293257
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2200 FLETCHER AVE $TH FLOOR
Address 2:
City:	FORT LEE
State:	NJ
Zip:	07024
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
CRYSTAL TANNER	PRODUCER	18098012	YES		10/17/2016
CRYSTAL WADE	PRODUCER	18095415	YES		10/17/2016
DAJA ROSELLE	PRODUCER	18095548	YES		10/17/2016
DANNY WILLIWAMS JR	PRODUCER	17849111	YES		10/17/2016
DELORES BANKS	PRODUCER	17325015	YES		10/17/2016
FELICIA UNDERDUE	PRODUCER	17623177	YES		10/17/2016
JALISHA JACKSON	PRODUCER	17327401	YES		10/17/2016
JEREMY WALKER	PRODUCER	17658861	YES		10/17/2016
KHYATIBEN PATEL	PRODUCER	18079030	YES		10/17/2016
KRYSTAL HAYDE	PRODUCER	17704572	YES		10/17/2016
LASHONDA YOUNGBLOOD	PRODUCER	17666236	YES		10/17/2016
LATOYA NIXON	PRODUCER	17020685	YES		10/17/2016
MELISSA SUMMERLIN	PRODUCER	18015398	YES		10/17/2016
MONICA COKE	PRODUCER	16988681	YES		10/17/2016
OSCAR BENITEZ	PRODUCER	17798489	YES		10/17/2016

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:	MICHELE LEASURE
Title:	LICENSING SPECIALIST
Phone Number:	3049293257
Email Address:	LICENSING@TZINSURANCE.COM