Notification of Changes for Business Entity
General Information
Business Entity Name:	ORYX INSURANCE BROKERAGE, INC.
Incorporation / Formation Date:
FEIN:	14-1786770
Ohio License Number:	1141381
NPN:	4530353
DBA / Trade Name:
State of Domicile:	NY
County:	BROOME
Business Address
Address 1:	2 COURT STREET
Address 2:
City:	BINGHAMTON
State:	NY
Zip:	13901
Phone:	860-571-3104
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	2 COURT STREET
Address 2:
City:	BINGHAMTON
State:	NY
Zip:	13901
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
DESIREE COLE	VICE PRESIDENT	123-62-2869	YES		06/01/2018
JOSHUA DAMON	TREASURER	383-06-2606	YES		06/01/2018
NATHAN GREER	VICE PRESIDENT, DIRECTOR	451-77-2609	YES		06/01/2018
STEVEN KNAPP	DIRECTOR	285-74-1897	YES		06/01/2018
STUART HOLLANDER	EXE VICE PRES, DIRECTOR	3393774	YES		06/01/2018
TIMOTHY ROBB	SECRETARY	133-52-7326	YES		06/01/2018

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:	CATHY KIMMEY
Title:	LICENSING SPECIALIST
Phone Number:	972-788-6811
Email Address:	PRODUCER.LICENSING@AMTRUSTGROUP.COM