Notification of Changes for Business Entity
General Information
Business Entity Name:	HCC CASUALTY INSURANCE SERVICES, INC.
Incorporation / Formation Date:
FEIN:	68-0101584
Ohio License Number:	1108120 & 33794
NPN:	953007
DBA / Trade Name:
State of Domicile:	CA
County:	CONTRA COSTA
Business Address
Address 1:	2300 CLAYTON ROAD, SUITE 1100
Address 2:
City:	CONCORD
State:	CA
Zip:	94520
Phone:	(925) 685-1600
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2300 CLAYTON ROAD, SUITE 1100
Address 2:
City:	CONCORD
State:	CA
Zip:	94520
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	YES	New DBA/Trade Name:	TOKIO MARINE HCC
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

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:	JOYCELYN RAY
Title:	VICE PRESIDENT
Phone Number:	(925) 685-1600
Email Address:	LALEXANDER@TMHCC.COM