Notification of Changes for Business Entity
General Information
Business Entity Name:	KEMBA FINANCIAL CREDIT UNION
Incorporation / Formation Date:
FEIN:	31-6034826
Ohio License Number:	8406521
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	FRANKLIN
Business Address
Address 1:	555 OFFICENTER PLACE
Address 2:
City:	GAHANNA
State:	OH
Zip:	43230
Phone:	614-235-2395
Fax:
Business Web Site Address:	WWW.KEMBA.ORG
Business Email Address:
Mailing Address
Address 1:	PO BOX 307370
Address 2:
City:	GAHANNA
State:	OH
Zip:	43230
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
ALI FARUNIA	AGENT	17867342		YES	09/06/16

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)	YES
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?	YES
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement	CREDIT UNION

Submitted By
Submitted By:	MARIA SMITH
Title:	EXECUTIVE ASSISTANT
Phone Number:	614-729-1399
Email Address:	MSMITH@KEMBA.ORG