Notification of Changes for Business Entity
General Information
Business Entity Name:	BMS INTERMEDIARIES, INC.
Incorporation / Formation Date:
FEIN:	752857254
Ohio License Number:
NPN:
DBA / Trade Name:	BMS RE US
State of Domicile:	MN
County:	HENNEPIN
Business Address
Address 1:	7650 EDINBOROUGH WAY, STE. 600
Address 2:
City:	EDINA
State:	MN
Zip:	55435
Phone:	9522240200
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	7650 EDINBOROUGH WAY, STE. 600
Address 2:
City:	EDINA
State:	MN
Zip:	55435
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	NO	Old Business Entity Name:
New DBA/Trade Name:	YES	New DBA/Trade Name:	BMS RE US
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:	CAROL HILL ON BEHALF OF ANDREW BUSTILLO (PRESIDENT)
Title:	AUTHORIZED PERSON
Phone Number:	817.800.5694
Email Address:	CHILL@ARCLICENSING.COM