Notification of Changes for Business Entity
General Information
Business Entity Name:	CUSO FINANCIAL SERVICES, INC.
Incorporation / Formation Date:
FEIN:	33-0726743
Ohio License Number:	25558
NPN:	1905937
DBA / Trade Name:
State of Domicile:	CA
County:	SAN DIEGO
Business Address
Address 1:	10150 MEANLEY DRIVE, 1ST FLOOR
Address 2:
City:	SAN DIEGO
State:	CA
Zip:	92131
Phone:	858-530-4400
Fax:
Business Web Site Address:	WWW.CUSONET.COM
Business Email Address:	LICENSING@CUSONET.COM
Mailing Address
Address 1:	10150 MEANLEY DRIVE, 1ST FLOOR
Address 2:
City:	SAN DIEGO
State:	CA
Zip:	92131
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:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date
DEREK SEARS	PRODUCER	17067614	YES		1/30/2017

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:	KIM PAO
Title:	REGISTRATION SPECIALIST
Phone Number:	858-530-4400
Email Address:	LICENSING@CUSONET.COM