Notification of Changes for Business Entity
General Information
Business Entity Name:	FINANCIAL INSURANCE SERVICES INC.
Incorporation / Formation Date:	08/01/1995
FEIN:	47-079-1671
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NE
County:	DOUGLAS
Business Address
Address 1:	5601 N 103RD STREET
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
Phone:	402-963-2361
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	5601 N 103RD STREET
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
TIFFANY BLANTON	AGENT	17974789	YES		07/12/2016
ANNA BOYD	AGENT	17948861	YES		07/12/2016
MITCHEL BURRISS	AGENT	17005033	YES		07/12/2016
TIARA COLEMAN	AGENT	17963024	YES		07/12/2016
TRAVIS COPELAND-FERGUSON	AGENT	17942052	YES		07/12/2016
DANIEL ENSLIN	AGENT	17942048	YES		07/12/2016
TIANNA GLEATON	AGENT	17950457	YES		07/12/2016
TIA GREENE	AGENT	17972545	YES		07/12/2016
GINA HYDE	AGENT	17947412	YES		07/12/2016
DAWN JOHNSON	AGENT	6413360	YES		07/12/2016
JYLISA LANE	AGENT	17936427	YES		07/12/2016
TAMMY MEDINA	AGENT	17950445	YES		07/12/2016
TAMMY METTS-FURR	AGENT	17942051	YES		07/12/2016
FAATIMAH MUHAMMAD	AGENT	17936389	YES		07/12/2016
MICHELLE NORTHUP	AGENT	17937656	YES		07/12/2016

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:	CODI BOWMAN
Title:	LICENSING SPECIALIST
Phone Number:	402-963-2361
Email Address:	AGENT@SITEL.COM