Notification of Changes for Business Entity
General Information
Business Entity Name:	SUTHERLAND GLOBAL SERVICES
Incorporation / Formation Date:
FEIN:	161287080
Ohio License Number:
NPN:	8372079
DBA / Trade Name:
State of Domicile:	NY
County:	MONROE
Business Address
Address 1:	1160 PITTSFORD VICTOR ROAD
Address 2:
City:	PITTSFORD
State:	NY
Zip:	14534
Phone:	8667748570
Fax:	7574311940
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	1313 EXECUTIVE BLVD
Address 2:
City:	CHESAPEAKE
State:	VA
Zip:	23320
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
COTTON, KIA	PRODUCER	18379706	YES		11/15/2017
CRAWFORD, KIMBERLY	PRODUCER	18379693	YES		11/15/2017
CROCKETT, KATRINA	PRODUCER	18494115	YES		11/15/2017
CURPHY, RHONDA J	PRODUCER	17757395	YES		11/15/2017
CURTIS, CALVANIQUE	PRODUCER	18390132	YES		11/15/2017
DANIELS, ISAAC	PRODUCER	17835552	YES		11/15/2017
DEISTER, TESSA	PRODUCER	17426510	YES		11/15/2017
DEPACE, GREGORY PAUL JR	PRODUCER	18369105	YES		11/15/2017
DYKES, ANIYUNWEA	PRODUCER	18385918	YES		11/15/2017
ENRIQUEZ, MATHEW	PRODUCER	18431697	YES		11/15/2017
FERRER, CHERRYLYN	PRODUCER	18538691	YES		11/15/2017
FLEISCHMAN, ROBERT	PRODUCER	18345915	YES		11/15/2017
GALTNEY, JULIUS	PRODUCER	18395626	YES		11/15/2017
GALVEZ, ROSEANNA	PRODUCER	18350187	YES		11/15/2017
GARCIA, COURTNEY MICHELE	PRODUCER	18343167	YES		11/15/2017

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:	CAROLYN CLARK
Title:	LICENSING SPECIALIST
Phone Number:	866-774-8570
Email Address:	CAROLYN.CLARK@SUTHERLANDGLOBAL.COM