Notification of Changes for Business Entity
General Information
Business Entity Name:	AAA CLUB ALLIANCE INC.
Incorporation / Formation Date:	11/15/2007
FEIN:	23-0758010
Ohio License Number:	31119
NPN:	7089389
DBA / Trade Name:
State of Domicile:	DE
County:	NEW CASTLE
Business Address
Address 1:	1 RIVER PLACE
Address 2:
City:	WILMINGTON
State:	DE
Zip:	19801
Phone:	8009994952
Fax:
Business Web Site Address:
Business Email Address:	BLINSURANCE@CSCGLOBAL.COM
Mailing Address
Address 1:	1 RIVER PLACE
Address 2:
City:	WILMINGTON
State:	DE
Zip:	19801
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	AAA ALLIED GROUP INC.
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

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:	MARYANN MARTONE
Title:	FILER
Phone Number:	8009279800
Email Address:	BLINSURANCE@CSCGLOBAL.COM