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:	OH
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
BONNETT, BRANDY	AGENT	7293545		YES	11-29-16
SOLES, SHERRI	AGENT	18140655		YES	11-29-16
SWEAT, AMY	AGENT	18033347		YES	11-29-16
TINDAL, ANDREW	AGENT	18057955		YES	11-29-16
CHAWGO, PAMELA	AGENT	18203399	YES		11-29-16
HOPKINS, TIERA	AGENT	18164647	YES		11-29-16
LABRA, ISRAEL	AGENT	18180019	YES		11-29-16
MATTINGLY, HEATHER	AGENT	18201857	YES		11-29-16
MCLIN, CHAD	AGENT	16725758	YES		11-29-16
SMITH, LELA	AGENT	16554858	YES		11-29-16
VELKOFF, CHANDRA	AGENT	18157160	YES		11-29-16
WHITE, DANIELLE	AGENT	18206881	YES		11-29-16
HUBBARD, JOHNATHAN	AGENT	18187256	YES		11-29-16

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:	JO WATERS
Title:	LICENSING SPECIALIST
Phone Number:	4029636973
Email Address:	JO.WATERS@SITEL.COM