Notification of Changes for Business Entity
General Information
Business Entity Name:	WELLS FARGO INS INC
Incorporation / Formation Date:	12/15/1986
FEIN:	410587845
Ohio License Number:	23765
NPN:	654461
DBA / Trade Name:
State of Domicile:	MN
County:	HENNEPIN
Business Address
Address 1:	550 S 4TH STREET
Address 2:
City:	MINNEAPOLIS
State:	MN
Zip:	55415
Phone:	6126675485
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	550 S 4TH STREET
Address 2:
City:	MINNEAPOLIS
State:	MN
Zip:	55415
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
MARIA BIESSENER DUNCAN	RDA	17657967	YES		05/13/2016

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)
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:	JODIANN RAINIER
Title:	LICENSING COORDINATOR
Phone Number:	8568332468
Email Address:	JODIANN.RAINIER@WELLSFARGO.COM