| Notification of Changes for Business Entity |
| General Information | |
| Business Entity Name: | TRAVEL GUARD GROUP INC |
| Incorporation / Formation Date: | 05/03/1994 |
| FEIN: | 391788198 |
| Ohio License Number: | 24334 |
| NPN: | 766344 |
| DBA / Trade Name: | |
| State of Domicile: | WI |
| County: | PORTAGE |
| Business Address | |
| Address 1: | 3300 BUSINESS PARK DRIVE |
| Address 2: | |
| City: | STEVENS POINT |
| State: | WI |
| Zip: | 54482 |
| Phone: | 7152955977 |
| Fax: | 7153450522 |
| Business Web Site Address: | |
| Business Email Address: | TGSTPCORPORATELICENSINGREQUESTS@AIG.COM |
| Mailing Address | |
| Address 1: | 3300 BUSINESS PARK DRIVE |
| Address 2: | |
| City: | STEVENS POINT |
| State: | NH |
| Zip: | 54482 |
| | |
| 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 |
| DENISE ZILCH | CALL CENTER REPRESENTATIVE | 16957630 | YES | | 02/08/2016 |
| CAITLIN ANN ZIPPERER | CALL CENTER REPRESENTATIVE | 17460148 | YES | | 02/08/2016 |
| JULIANNA ROSE ZURAWSKI | CALL CENTER REPRESENTATIVE | 17184305 | YES | | 02/08/2016 |
| MICHELLE ELIZABETH BRUESEWITZ | CALL CENTER REPRESENTATIVE | 16108776 | YES | | 02/08/2016 |
| PATRICIA DIANE CARREN | CALL CENTER REPRESENTATIVE | 10924320 | YES | | 02/08/2016 |
| ROBERT ALLEN HECKEL | CALL CENTER REPRESENTATIVE | 9916432 | YES | | 02/08/2016 |
| BENJAMIN ROBERT KOLLOCK | CALL CENTER REPRESENTATIVE | 10673322 | YES | | 02/08/2016 |
| GRACE ELIZABETH MIJAL | CALL CENTER REPRESENTATIVE | 10559890 | YES | | 02/08/2016 |
| BRENDA ANN RETZLAFF | CALL CENTER REPRESENTATIVE | 15707380 | YES | | 02/08/2016 |
| MELISSA CLAIRE WEISS-KOZLOWSKI | CALL CENTER REPRESENTATIVE | 10559915 | YES | | 02/08/2016 |
| CHARLES THOMAS WELLER | CALL CENTER REPRESENTATIVE | 15754047 | YES | | 02/08/2016 |
| | | | | | |
| 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 | |