Fill and Sign the State of South Carolina Secretary of State Application for an Form

STATE OF SOUTH CAROLINA SECRETARY OF STATE APPLICATION BY A FOREIGN CORPORATION FOR A CERTIFICATE OF AUTHORITY TO TRANSACT BUSINESS IN THE STATE OF SOUTH CAROLINA TYPE OR PRINT CLEARLY WITH BLACK INK Pursuant to Section 33-15-103 of the 1976 South Carolina Code of Laws, as amended, the undersigned corporation hereby applies for authority to transact business in the State of South Carolina, and for that purpose, hereby submits the following statement: 1. The name of the corporation is (see Sections 33 -4-101 and 33-15-106 and Section 33-19-500(b)(1) if the corporation is a professional corporation) __________________________________________________. (Must match corporation name on certificate of existence from dom estic state) 2. It is incorporated as (check applicable item) [ ] a general business corporation, [ ] a professional corporation, under the laws of the state of ______________________________________________. 3. The date of its incorporation is _________________ and the period of its duration is __________________. 4. The address of the principal office of t he corporation is ________________________________ in the Street Address city of ________________________ and the state of ___________________________________. Zip Code 5. The address of the proposed registered office the state of South Carolina is ___________________________________ in the city of _____________________________ in Street Address South Carolina ____________________________. Zip Code 6. The name of the proposed registered agent in South Carolina at such address is _______________________________________________________________________ Print Name I hereby consent to the appointment as registered agent of the corporation. _______________________________________________________________________ Signature of the Registered Agent Form Revised by South Carolina Secretary of State, March 2012 _________\ _______________________ Name of Corporation 7. The name and usual business address of the corporation's directors (if the corporation has no directors, then the name and address of the persons who are exercising the statutor y authority of the directors on behalf of the corporation) and principal officers: a.) Name of Directors Business Address ____________________________________ ______________________________________ ____________________________________ ______________________________________ ____________________________________ ______________________________________ ____________________________________ ______________________________________ b.) Name and Office of Principal Officers Business Address ____________________________________ ______________________________________ ____________________________________ ______________________________________ ____________________________________ ______________________________________ ____________________________________ ______________________________________ 8. The aggregate number of shares which the corporat ion has authority to issue, itemized by classes and series, if any, within a class: (if no shares are issued please enter “none”) Class of Shares (and Series, if any) Authorized Number of Each Class (and Series) ____________________________________ ______________________________________ ____________________________________ ______________________________________ ____________________________________ ______________________________________ 9. Unless a delayed date is specified, this applicati on shall be effective when accepted for filing by the Secretary of State (See Section 33-1 -230):______________________________________________ Date ________________________ ________________________________ Name of Corporation ________________________________ Signature of Officer ________________________________ Type or Print Name ________________________________ Position of Officer Form Revised by South Carolina Secretary of State, March 2012 FILING INSTRUCTIONS 1. Two copies of this form must be submitted for filing. 2. If the space in this form is insuffi cient, please attach additional sheets containing a reference to the appropriate paragraph in this form. 3. $135.00 filing fee made payable to the South Carolina Secretary of State. Fee for filing Application $110.00 Annual Report $25.00 Total $135.00 4. Self-addressed stamped return envelope. 5. This form must be accompanied by the South Carolina Initial Annual Report of Corporations (CL-1 Form) 6. An original certificate of existence no more than 30 days old from the official st ate of jurisdiction where the corporation is incorporated. 7. If the applicant corporation's domestic name is unavailable in South Carolina, then it must file a certified copy of the board Of directors resolution approving the fictitious name along with this application pursuant to Section 33-15-106(a)(2). (additional $10 filing fee) 8. If the applicant is a foreign professional corporation, then in addition to satisfying the name requirements in Sections 33-19-150 and 33-19-500(b)(1), the following information must be included in the application: a) A statement that the corpor ation's sole business purpose is to engage in a specified form of professional services (e.g. Law firm). b) A statement that all of its shareholders, not less than one-half of its di rectors, and all of its officers other than its secretary or treasurer, if any, are licensed in one or more states to render a professional service described in its articles of incorporation. 9. Return to: Secretary of State Attn: Corporations 1205 Pendleton St., Ste. 525 Columbia, SC 29201 NOTE THE FILING OF THIS DOCUMENT DOES NOT, IN AND OF ITSELF, PROVIDE AN EXCLUSIVE RIGHT TO USE THIS CORPORATE NAME ON OR IN CONNECTION WITH ANY PRO DUCT OR SERVICE. USE OF A NAME AS A TRADEMARK OR SERVICE MARK WILL REQUIRE FURTHER CLEARANCE AND REGISTRATION AND BE AFFECTED BY PRIOR USE OF THE MARK. FOR MORE INFORMATION, CONTACT THE TRADEMARKS DIVISION OF THE SECRETARY OF STATE'S OFFICE.