Notification of Changes for Business Entity
General Information
Business Entity Name:	SUTHERLAND GLOBAL SERVICES
Incorporation / Formation Date:
FEIN:	16-1287080
Ohio License Number:	32628
NPN:	8372079
DBA / Trade Name:
State of Domicile:	NY
County:	USA
Business Address
Address 1:	1160 PITTSFORD VICTOR ROAD
Address 2:
City:	PITTSFORD
State:	NY
Zip:	14534
Phone:	8667748570
Fax:	7574311940
Business Web Site Address:
Business Email Address:	JANELLE.CARRERA@SUTHERLANDGLOBAL.COM
Mailing Address
Address 1:	1313 EXECUTIVE BLVD
Address 2:
City:	CHESAPEAKE
State:	VA
Zip:	23320
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
MARICAR KNOX	PRODUCER	1058245	YES		12-01-2016
GWENITA LAWTON	PRODUCER	1053514	YES		12-01-2016
EBONEE ORTON-FIELDS	PRODUCER	1055385	YES		12-01-2016
WILLIAM RANDALL	PRODUCER	1061946	YES		12-01-2016
DANYELL BRILEY	PRODUCER	1125631	YES		12-01-2016
JAMES CLIFTON, JR	PRODUCER	1060416	YES		12-01-2016
NADINE GLENN-STUBBLEFIELD	PRODUCER	1054641	YES		12-01-2016
J SCOTT OERTEL	PRODUCER	1076471	YES		12-01-2016
LAWANDA RICKS	PRODUCER	1114456	YES		12-01-2016
ALISHA WATT	PRODUCER	1105483	YES		12-01-2016
EMY RODRIGUEZ	PRODUCER	1064828	YES		12-01-2016
LAURALEE SONIA	PRODUCER	1029052	YES		12-01-2016
BRANDON THOMPSON	PRODUCER	1054379	YES		12-01-2016
CAROL VANCAMP	PRODUCER	1023121	YES		12-01-2016
DAYANA TANIOUS	PRODUCER	1058250	YES		12-01-2016

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)	NO
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?	NO
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:	CAROLYN CLARK
Title:	LICENSING ADMIN
Phone Number:	866-774-8570
Email Address:	CAROLYNL.CLARK@SUTHERLANDGLOBAL.COM