Notification of Changes for Business Entity
General Information
Business Entity Name:	CWIBENEFITS, INC.
Incorporation / Formation Date:	1/25/1988
FEIN:	570870204
Ohio License Number:	1068735
NPN:	8265478
DBA / Trade Name:
State of Domicile:	DE
County:	KENTY
Business Address
Address 1:	80 INTERNATIONAL DRIVE
Address 2:	SUITE 500
City:	GREENVILLE
State:	SC
Zip:	29615
Phone:	8642348200
Fax:	8642348202
Business Web Site Address:
Business Email Address:	PJOYCE@PATNAT.COM
Mailing Address
Address 1:	P. O. BOX 6125
Address 2:
City:	GREENVILLE
State:	SC
Zip:	2960
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

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date
JAMES RINERE	PRESIDENT	066603644	YES		6/12/2017
BETH CREWS	PRESIDENT	149624202		YES	6/12/2017

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:	BETH CREWS
Title:	SECRETARY
Phone Number:	9546702900
Email Address:	BCREWS@PATNAT.COM