Notification of Changes for Business Entity
General Information
Business Entity Name:	CETERA ADVISOR NETWORKS INSURANCE SERVICES LLC
Incorporation / Formation Date:
FEIN:	330232417
Ohio License Number:	33365
NPN:
DBA / Trade Name:
State of Domicile:	CA
County:	LOS ANGELES
Business Address
Address 1:	200 N. PACIFIC COAST HIGHWAY #1300
Address 2:
City:	EL SEGUNDO
State:	CA
Zip:	90245
Phone:	8008798100
Fax:	3107841110
Business Web Site Address:
Business Email Address:	MAXINE.SIMMS@CETERA.COM
Mailing Address
Address 1:	200 N. PACIFIC COAST HIGHWAY #1300
Address 2:
City:	EL SEGUNDO
State:	CA
Zip:	90245
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)
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:	MAXINE SIMMS
Title:	DIRECTOR OF LICENSING
Phone Number:	310-257-7570
Email Address:	MAXINE.SIMMS@CETERA.COM