Notification of Changes for Business Entity
General Information
Business Entity Name:	TRIP MATE, INC
Incorporation / Formation Date:
FEIN:	48-1062722
Ohio License Number:	41648
NPN:
DBA / Trade Name:
State of Domicile:	MO
County:	JACKSON
Business Address
Address 1:	9225 WARD PKWY
Address 2:
City:	KANSAS CITY
State:	MO
Zip:	64114
Phone:	630-694-5280
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	9225 WARD PKWY
Address 2:
City:	KANSAS CITY
State:	MO
Zip:	64114
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
AMBER GORE	PRODUCER	9050633	YES		10/03/2017

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:	JULIETTE CASH
Title:	BPO CLERK
Phone Number:	9196535459
Email Address:	JULIETTE.CASH@REGED.COM