Notification of Changes for Business Entity
General Information
Business Entity Name:	FINANCIAL INSURANCE SERVICES INC
Incorporation / Formation Date:
FEIN:	470791671
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	OH
County:	DOUGLAS
Business Address
Address 1:	5601 N 103RD ST
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
Phone:	4029632361
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	5601 N 103RD ST
Address 2:
City:	OMAHA
State:	NE
Zip:	68134
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
DHOM, MATTHEW	AGENT	18699387	YES		04/02/2018
DISHONGH, PAMELA	AGENT	18510035	YES		04/02/2018
EBLE, SELINA	AGENT	18699315	YES		04/02/2018
ELLEDGE, PATRICIA	AGENT	18662269	YES		04/02/2018
HOWARD-KELLEY, TINA	AGENT	18699372	YES		04/02/2018
JOHNSON , ANGELA	AGENT	18699365	YES		04/02/2018
MARCIE, KRISSTINA	AGENT	18609337	YES		04/02/2018
MARTIN, SCOTT	AGENT	18699619	YES		04/02/2018
MEADE, DYLAN	AGENT	18662276	YES		04/02/2018
MILLER, HAILEY	AGENT	18698451	YES		04/02/2018
PATTERSON, ANDREW	AGENT	16962462	YES		04/02/2018
ROBERTS, TIMOTHY	AGENT	18698333	YES		04/02/2018
THOMPSON, JENNIFER	AGENT	18665490	YES		04/02/2018
UMBEHAGEN, MARK	AGENT	18698389	YES		04/02/2018
ALLEN, MAYCEL	AGENT	18674277	YES		04/02/2018

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:	STACY DEVAUGHAN
Title:	LICENSING SPECIALIST
Phone Number:	4029632361
Email Address:	AGENT@SITEL.COM