Notification of Changes for Business Entity
General Information
Business Entity Name:	AMERICAN FIDELITY GENERAL AGENCY INC
Incorporation / Formation Date:	10/19/1989
FEIN:	731352431
Ohio License Number:	24068
NPN:	1997743
DBA / Trade Name:
State of Domicile:	OK
County:	OKLAHOMA
Business Address
Address 1:	9000 CAMERON PKWY
Address 2:	9TH FLOOR
City:	OKLAHOMA CITY
State:	OK
Zip:	73114
Phone:	4055235716
Fax:	8006208974
Business Web Site Address:
Business Email Address:	KRISTIN.KING@AMERICANFIDELITY.COM
Mailing Address
Address 1:	PO BOX 25360
Address 2:
City:	OKLAHOMA CITY
State:	OK
Zip:	73125
Indicate the type of change you are seeking
Address Change:	YES
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

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:	KRISTIN L. KING
Title:	LICENSING TEAM LEADER
Phone Number:	4055235716
Email Address:	KRISTIN.KING@AMERICANFIDELITY.COM