Notification of Changes for Business Entity
General Information
Business Entity Name:	TZ INSURANCE, INC.
Incorporation / Formation Date:
FEIN:	271602268
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NJ
County:	BELGEN
Business Address
Address 1:	2200 FLETCHER AVE
Address 2:	4TH FLOOR
City:	FORT LEE
State:	NJ
Zip:	07024
Phone:	304-929-3257
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2200 FLETCHER AVE
Address 2:	4TH FLOOR
City:	FORT LEE
State:	NJ
Zip:	07024
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
ELIJAH HOLLOWAY	PRODUCER	17387092	YES		05/08/2016
EMMA PLAYER	PRODUCER	17036327	YES		05/08/2016
ERIC THOMPSON	PRODUCER	7681950	YES		05/08/2016
ERIC YOUMANS	PRODUCER	16953888	YES		05/08/2016
ERICK AHRENS	PRODUCER	8898354	YES		05/08/2016
EVE LOSEK	PRODUCER	17682223	YES		05/08/2016
FABIAN ST-HUBERT	PRODUCER	17484810	YES		05/08/2016
FELICIA MCLLWAIN	PRODUCER	17466114	YES		05/08/2016
FELICIDAD DAVILA	PRODUCER	17235684	YES		05/08/2016
FRANCES GANTNER	PRODUCER	8631288	YES		05/08/2016
FRANK LICITRA	PRODUCER	7094141	YES		05/08/2016
GABRIELA MENDEZ	PRODUCER	17055618	YES		05/08/2016
GARY JOHNSON	PRODUCER	1752157	YES		05/08/2016
GERALD SIMPSON	PRODUCER	16906487	YES		05/08/2016
GLEN VANDERWALKER	PRODUCER	17026278	YES		05/08/2016

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:	MICHELE LEASURE
Title:	LICENSING SPECIALIST
Phone Number:	304-929-3257
Email Address:	LICENSING@TZINSURANCE.COM