Notification of Changes for Business Entity
General Information
Business Entity Name:	PACIFIC SELECT DISTRIBUTORS, LLC
Incorporation / Formation Date:
FEIN:	95-2594489
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	DE
County:	ORANGE
Business Address
Address 1:	700 NEWPORT CENTER DRIVE
Address 2:
City:	NEWPORT BEACH
State:	CA
Zip:	92660
Phone:	8008007681
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	700 NEWPORT CENTER DRIVE
Address 2:
City:	NEWPORT BEACH
State:	CA
Zip:	92660
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
GREGORY KEELING	CFO	385-70-4034	YES		6/28/17
DAWN TRAUTMAN	EX. VICE PRESIDENT	180-62-2581	YES		6/28/17
SHARON PACHECO	VICE PRESIDENT	576-64-0081	YES		6/28/17
JOHN WHITE	VICE PRESIDENT	211-52-7121	YES		6/28/17
MICHAEL LIETZOW	ASST. VICE PRESIDENT	609-30-1884	YES		6/28/17

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:	ALICE PALMQUIST TERLECKY
Title:	VICE PRESIDENT
Phone Number:	8008007681
Email Address:	MARNIE.ALMERO@PACIFICLIFE.COM