Notification of Changes for Business Entity
General Information
Business Entity Name:	GWC WARRANTY CORPORATION
Incorporation / Formation Date:
FEIN:	232797592
Ohio License Number:
NPN:
DBA / Trade Name:
State of Domicile:	PA
County:	LUZERNE
Business Address
Address 1:	SHOWROOM LEVEL
Address 2:	40 COAL ST
City:	WILKES BARRE
State:	PA
Zip:	18702
Phone:	570-414-7777
Fax:
Business Web Site Address:
Business Email Address:
Mailing Address
Address 1:	PO BOX 7900
Address 2:
City:	WLKES BARRE
State:	PA
Zip:	18773
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
CHRISTOPHER BARRY	RDA	16502602		YES	10/25/2016
JOHN LEE	RDA	7973540	YES		10/25/2016

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:	JANNA BELL
Title:	LICENSING ADMINISTRATOR
Phone Number:	812-886-0191
Email Address:	JBELL@SUPPORTIVEIS.COM