Notification of Changes for Business Entity
General Information
Business Entity Name:	DKG INSURANCE & FINANCIAL SERVICES, INC.
Incorporation / Formation Date:
FEIN:	75-2854608
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	TX
County:	DALLAS COUNTY
Business Address
Address 1:	12404 PARK CENTRAL DR, STE 400S
Address 2:
City:	DALLAS
State:	TX
Zip:	75251
Phone:	972-457-3693
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	12404 PARK CENTRAL DR, STE 400S
Address 2:
City:	12404 PARK CENTRAL DR, STE 400
State:	TX
Zip:	75251
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
RONALDO ALFONSO	DRLP	450611	YES		02/13/2018

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:	CSC
Title:	AUTHORIZED SUBMITTER
Phone Number:	8009279801
Email Address:	ALYSSA.DOHERTY@CSCGLOBAL.COM