Notification of Changes for Business Entity
General Information
Business Entity Name:	NORTH AMERICAN CASUALTY CO.
Incorporation / Formation Date:
FEIN:	203785366
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	NE
County:	DOUGLAS
Business Address
Address 1:	10805 OLD MILL ROAD
Address 2:
City:	OMAHA
State:	NE
Zip:	68154
Phone:	4028273416
Fax:
Business Web Site Address:
Business Email Address:	INSADMIN@AUW.COM
Mailing Address
Address 1:	PO BOX 3646
Address 2:
City:	OMAHA
State:	NE
Zip:	68103
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
XIAOYUN ASHLEY HU	RDA	13452455		YES	5/19/17
CHRISTOPHER M LAMANTIA	RDA	8353963		YES	5/19/17

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:	JEFFREY SILVER
Title:	SECRETARY
Phone Number:	4028273416
Email Address:	INSADMIN@AUW.COM