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:	402-963-2361
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
FREEMAN, JASMIN	AGENT	18722769	YES		04/02/2018
GASTON, KRISTIANA	AGENT	18725926	YES		04/02/2018
GILLON, VANESSA	AGENT	18725919	YES		04/02/2018
GOODEN, JANADREA	AGENT	18674343	YES		04/02/2018
GOSS, JASMINE	AGENT	17547855	YES		04/02/2018
GRANT, JAMIREYA	AGENT	18629083	YES		04/02/2018
HARRISON, SHANICE	AGENT	18689654	YES		04/02/2018
HATHORN, BRIA	AGENT	18629043	YES		04/02/2018
HAWKINS, KABRINA	AGENT	18674331	YES		04/02/2018
HILL, DONEKA	AGENT	18679855	YES		04/02/2018
HOGAN, WILMA	AGENT	18674332	YES		04/02/2018
HOLLIDAY, CHELSEA	AGENT	18698878	YES		04/02/2018
HOOK, MICHELLE	AGENT	18631678	YES		04/02/2018
HUBBARD-BOONE, DEJA	AGENT	18698874	YES		04/02/2018
JAMISON, TENNIELLE	AGENT	18631706	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