Notification of Changes for Business Entity
General Information
Business Entity Name:	WILLIS OF VERMONT, INC.
Incorporation / Formation Date:
FEIN:	03-0212176
Ohio License Number:	33073 AND 930974
NPN:	1639355
DBA / Trade Name:
State of Domicile:	VT
County:	CHITTENDEN
Business Address
Address 1:	100 BANK STREET, SUITE 500
Address 2:
City:	BURLINGTON
State:	VT
Zip:	05401
Phone:	6158723038
Fax:	6158664184
Business Web Site Address:
Business Email Address:	ANN.WESTPHAL@WILLISTOWERSWATSON.COM
Mailing Address
Address 1:	100 BANK STREET, SUITE 500
Address 2:
City:	BURLINGTON
State:	VT
Zip:	05401
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	SMITH BELL AND THOMPSON INC
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:	ANN WESTPHAL
Title:	LICENSING ADMINISTRATOR
Phone Number:	615-872-3038
Email Address:	ANN.WESTPHAL@WILLISTOWERSWATSON.COM