Notification of Changes for Business Entity
General Information
Business Entity Name:	FINANCIAL INSURANCE SERVICES INC
Incorporation / Formation Date:
FEIN:	470791671
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	DOUGLAS
Business Address
Address 1:	5601 N 103RD ST
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
Phone:	4029632361
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	5601 N 102RD ST
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
SHERIDAN, DEREK	AGENT	18068493		YES	10-21-16
MILLER, AMY	AGENT	18109433		YES	10-21-16
GUIDER, ZACHARY	AGENT	17912048		YES	10-21-16
COLE, DANIELLE	AGENT	17883157		YES	10-21-16
BROWN, RACQUEAL	AGENT	17883140		YES	10-21-16
WILSON, KRISTOFER	AGENT	8403261		YES	10-21-16
TAYLOR, WILSON	AGENT	17865135		YES	10-21-16
LANCASTER, REBECCAH	AGENT	18149077	YES		10-21-16
POTTER, MARLEY	AGENT	18128710	YES		10-21-16
WALDROP, COREY	AGENT	18112326	YES		10-21-16
OTUWA, SAMUEL	AGENT	18129230	YES		10-21-16
BRIDGES, JORDAN	AGENT	18136776	YES		10-21-16
FUNCHES, LATRON	AGENT	18144401	YES		10-21-16
MCCOY, MICHELE	AGENT	18123427	YES		10-21-16

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:	JO WATERS
Title:	LICENSING SPECIALIST
Phone Number:	4029636973
Email Address:	JO.WATERS@SITEL.COM