Notification of Changes for Business Entity
General Information
Business Entity Name:	E*TRADE INSURANCE SERVICES, INC.
Incorporation / Formation Date:	12/05/2001
FEIN:	94-3413228
Ohio License Number:	29141
NPN:	7323249
DBA / Trade Name:
State of Domicile:	CA
County:	SAN MATEO
Business Address
Address 1:	4500 BOHANNON BLVD.
Address 2:
City:	MENLO PARK
State:	CA
Zip:	94025
Phone:	678-319-7157
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	4500 BOHANNON BLVD.
Address 2:
City:	MENLO PARK
State:	CA
Zip:	94025
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
KEITH HUBER	VICE PRESIDENT / RDA	16073305	YES		12-20-16

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
WALTER B. DOGGETT, III	VICE PRESIDENT	247-51-0950	YES		12-20-2016
JOHN C. COTE	VICE PRESIDENT	387-74-1230	YES		12-20-2016
KEITH HUBER	VICE PRESIDENT	16073305	YES		12-20-2016
LORI SHER	SECRETARY	437-27-8337	YES		12-20-2016
CHAD TURNER	CFO	362-96-0889	YES		12-20-2016
MICHAEL FOLEY	DIRECTOR	102-62-4458	YES		12-20-2016
GEORGE SCOTT WHITE	NO LONGER EMPLOYED			YES	12-20-2016
JOHN BUCHMAN	NO LONGER EMPLOYED			YES	12-20-2016
MARK D. HANSEN	NO LONGER EMPLOYED			YES	12-20-2016
MICHAEL CURCIO	NO LONGER EMPLOYED			YES	12-20-2016

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

Submitted By
Submitted By:	KEITH HUBER
Title:	VICE PRESIDENT
Phone Number:	646-521-4456
Email Address:	KEITH.HUBER@ETRADE.COM