Notification of Changes for Business Entity
General Information
Business Entity Name:	EMA BROKERAGE LLC
Incorporation / Formation Date:
FEIN:	23-3057456
Ohio License Number:	28787
NPN:	3943696
DBA / Trade Name:
State of Domicile:	NJ
County:	CAMDEN
Business Address
Address 1:	108 KINGS HIGHWAY EAST
Address 2:	SUITE 220
City:	HADDONFIELD
State:	NJ
Zip:	08033
Phone:	8562160211
Fax:	8562958727
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	108 KINGS HIGHWAY EAST
Address 2:	SUITE 220
City:	HADDONFIELD
State:	NJ
Zip:	08033
Indicate the type of change you are seeking
Address Change:	YES
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

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)	NO
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?	NO
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:	KAITLYN HAGARTY
Title:	CASE MANAGER
Phone Number:	8562160211
Email Address:	KAITLYNH@EMABROKERAGE.COM