Notification of Changes for Business Entity
General Information
Business Entity Name:	WTR UNDERWRITING
Incorporation / Formation Date:	06/04/2013
FEIN:	383909582
Ohio License Number:	1017857
NPN:	16990960
DBA / Trade Name:
State of Domicile:	CT
County:	FAIRFIELD
Business Address
Address 1:	ONE LANDMARK SQ. 6TH FL
Address 2:
City:	STAMFORD
State:	CT
Zip:	06901
Phone:	2036630900
Fax:
Business Web Site Address:	WWW.WALDORFTRADERISK.COM
Business Email Address:	SYLVIA@WALDORFTRADERISK.COM
Mailing Address
Address 1:	ONE LANDMARK SQ. 6TH FL
Address 2:
City:	STAMFORD
State:	CT
Zip:	06901
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:	SYLVIA BECKERMAN
Title:	COO
Phone Number:	2036630900
Email Address:	SYLVIA@WALDORFTRADERISK.COM