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:	4029632361
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
BIGMEAT, NOAH	AGENT	18688167	YES		04/02/2018
BROWN, KELSEY	AGENT	18725753	YES		04/02/2018
CARPENTER, SHERIDAN	AGENT	15860761	YES		04/02/2018
CASSELS, KIM	AGENT	18688168	YES		04/02/2018
COLLINS, SAVANA	AGENT	18649997	YES		04/02/2018
CORNEJO, MEGHAN	AGENT	18725761	YES		04/02/2018
CUNNINGHAM, JENNIFER	AGENT	18667428	YES		04/02/2018
CURTIS, ELISHA	AGENT	15707601	YES		04/02/2018
DANIELS, NIA	AGENT	18672907	YES		04/02/2018
FELTUS-WIMBERLY, TIAIJAH	AGENT	18661384	YES		04/02/2018
FENWICK, MIA	AGENT	18714160	YES		04/02/2018
FINISTER, BREONNA	AGENT	18692870	YES		04/02/2018
GRIDEN, ANGELA	AGENT	15985928	YES		04/02/2018
GUINTIVANO, RANDY	AGENT	18683991	YES		04/02/2018
HAVEN, DIANA	AGENT	18691406	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