Notification of Changes for Business Entity
General Information
Business Entity Name:	FINANCIAL INSURANCE SERVICES INC
Incorporation / Formation Date:
FEIN:	470791671
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NE
County:	DOUGLAS
Business Address
Address 1:	5601 N 103RD ST
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
Phone:	4029632361
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	5601 N 103RD ST
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
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
TAYLOR, ALEXIS	AGENT	18631702	YES		04/02/2018
THOMPSON, ERICA	AGENT	18630417	YES		04/02/2018
TRIPLETT, MARIA	AGENT	18665145	YES		04/02/2018
TURNER, JUSTIN	AGENT	18725937	YES		04/02/2018
WARD, JONIQUA	AGENT	18724146	YES		04/02/2018
WASHINGTON, KRISTIAN	AGENT	18724124	YES		04/02/2018
WASHINGTON, TYLESHA	AGENT	18698879	YES		04/02/2018
YOUNG, TIFFANY	AGENT	18697024	YES		04/02/2018
ABRAMOVICH, ARTUR	AGENT	18667701	YES		04/02/2018
ALIX JR, JASON ANDRE	AGENT	18683993	YES		04/02/2018
ALLEN, MICHAEL	AGENT	18712803	YES		04/02/2018
ALWIN, MICHAEL	AGENT	54676	YES		04/02/2018
ARMENTROUT, JESSICA	AGENT	18725760	YES		04/02/2018
ASHLEY, ASHLEY	AGENT	18661473	YES		04/02/2018
BEST, DOMONIQUE	AGENT	18667690	YES		04/02/2018

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:	STACY DEVAUGHAN
Title:	LICENSING SPECIALIST
Phone Number:	4029632361
Email Address:	AGENT@SITEL.COM