Application For Certificate Of Authority Foreign Professional Corporation {PC-01}

BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622 (Revised July 2017) (Form PC-01) State of North Carolina Department of the Secretary of State APPLICATION FOR CERTIFICATE OF AUTHORITY FOREIGN PROFESSIONAL CORPORATION Pursuant to Section 55B-16 of the General Statutes of North Carolina, the undersigned corporation hereby applies for a Certificate of Section 55B-16(b)), and for that purpose submits the following: 1. The name of the corporation is ; and if the corporate name is unavailable for use in the State of North Carolina, the name the corporation wishes to use is: 2. The state or country under whose laws the corporation was incorporated is: 3. The date of incorporation was ; its period of duration is: 4. The street address of the principal office of the corporation is: Number and Street City, State, Zip Code 5. The mailing address if different from the street address of the principal office of the corporation is: 6. The street address and county of the registered office in the State of North Carolina is: Number and Street City, State, Zip Code County 7. The mailing address if different from the street address of the registered office in the State of North Carolina is: 8. The name of the registered agent in the State of North Carolina is: 9. The names, titles, and usual business addresses of the current officers of the corporation are: (use attachment if necessary) Name Title Business Address American LegalNet, Inc. www.FormsWorkFlow.com BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622 (Revised July 2017) (Form PC-01) APPLICATION FOR CERTIFICATE OF AUTHORITY Page 2 10. Attached is a certificate of existence (or document of similar import), duly authenticated by the secretary of state or other official having custody of corporate records in the state or country of incorporation. 11. If the corporation is required to use a fictitious name in order to transact business in this State, a copy of the resolution of its board of directors, certified by its secretary, adopting the fictitious name is attached. 12. The professional services to be rendered by the corporation are 13. With respect to each professional service to be practiced through the corporation in this State, the names and titles of at least one profession in this State are: (use attachment if necessary) Name Title defined in N.C.G.S. Section 55B-2(2). 15. This application will be effective upon filing, unless a delayed date and/or time is specified: This the day of , 20 By executing this application on behalf of the applicant corporation, I certify under oath that the undersigned corporation -16(b). Name of Corporation Signature of Officer or Chairman of Board of Directors Type or Print Name and Title American LegalNet, Inc. www.FormsWorkFlow.com BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622 (Revised July 2017) (Form PC-01) (site of acknowledgment) This day of , 20, personally came before me, , Notary Public, , who, being by me duly sworn, says that he/she is of , a corporation, and that this application for certificate of authority was signed by him/her on behalf of the corporation by its authority duly given. And the said acknowledged the said writing to be the act and deed of said corporation. Witness my hand and official seal, this the day of , 20. (Official Seal) Notary Public My commission expires , 20. Notes: 1. Filing fee is $250. This document must be filed with the Secretary of State. 2. For additional instructions, see the following page of this form. American LegalNet, Inc. www.FormsWorkFlow.com BUSINESS REGISTRATION DIVISION P. O. BOX 29622 RALEIGH, NC 27626-0622 (Revised July 2017) (Form PC-01) Instructions for Filing FOREIGN PROFESSIONAL CORPORATION APPLICATION FOR CERTIFICATE OF AUTHORITY (Form PC-01) WHICH CORPORATIONS CAN USE THIS FORM? -definition, is: (a) a corporation, (c) which is incorporated under a law other than the law of North Carolina, (d) which is incorporated for the sole and specific N.C.G.S. Section 55B-2(6), AND (e) which meets one of the three following requirements: (1) the corporation has as its shareholders only individuals who are licensed, either in North Carolina or in some other state, to render the same professional services as the corporation renders; OR (2) the corporatiGeneral Statutes AND has as its shareholders only individuals who are licensed, either in North Carolina or in some other state, to render the same professional services as the corporation renders or who are unlicensed employees of the corporation who own not more than one-s stock; OR (3) the corporation is one which is described in N.C.G.S. Section 55B-15 (the so-Professional Corporation Act). Only Item 1 Enter the complete name of the corporation exactly as it appears in the records of the official custodian of corporate records in the state or country of incorporation. If that name cannot be used in North Carolina, enter the name (including a corporate ending) that it wishes to use in North Carolina. Item 5 only if mail is not delivered to the street address above or if the corporation prefers to receive mail at a P.O. Box or Drawer. Item 7 only if mail is not delivered to the street address above or if the corporation prefers to receive mail at a P.O. Box or Drawer. Item 8 Enter the name of the registered agent. The registered agent must be a North Carolina resident, an existing domestic corporation, or a foreign corporation authorized to do business in North Carolina. Item 15 The document will be effective on the date and at the time of filing, unless a delayed date and/or time is specified. If a delayed effective date and time is specified, the document will be effective on that date and time. A delayed effective date may be specified up to and including the 90th day after the day of filing. If a delayed effective date is specified without a time, the document will be effective at 11:59:59 p.m. Date and Execution: Enter the date the document was executed. In the blanks provided enter: The name of the corporation executing the statement. The signature of the representative of the corporation (may be the chairman of the board of directors or any officer of the corporation). The name and title of the above-signed representative. The corporate representative executing this application must be placed under oath, and the acknowledgment must be completed by a person authorized by law to administer oaths. American LegalNet, Inc. www.FormsWorkFlow.com