STATE OF SOUTH CAROLINA 
                                            SECRETARY OF STATE 

                          APPLICATION BY A FOREIGN NONPROFIT CORPORATION 
                           FOR A CERTIFICATE OF AUTHORITY 
                                     TO TRANSACT BUSINESS 
                           IN THE STATE OF SOUTH CAROLINA 

Pursuant to Section 33-31-1503 of the 1976 S.C. Code of Laws, as amended, the undersigned nonprofit 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 foreign nonprofit corporation      :is

2. The corporation is incorporated under the laws of: 
   _____________________________________________________________________________________________                        
   (State or Country)

3. The corporation was incorporated on: __________ and its duration is (complete “a” or “b”, whichever is applicable)

   a.    Perpetual

   b.    ______________________________________________________________________________________

4. The principal office of the foreign corporation is:

   _____________________________________________________________________________________________                        
   (Street Address) 
   _____________________________________________________________________________________________                        
   (City, State, Zip Code)

5. The registered office of the foreign corporation in South Carolina is:

   _____________________________________________________________________________________________                        
   (Street Address) 
   _____________________________________________________________________________________________                        
   (City, State, Zip Code)

6. The name of the registered agent of the corporation at that office is:

   _____________________________________________________________________________________________                        
   (Name)
   I hereby consent to the appointment as registered agent of the corporation. 

   _____________________________________________________________________________________________                        
   (Agent’s Signature) 

                                                         Form Revised by South Carolina Secretary ofOctoberState,  201 8
                                                                                                    F0013 

                                                                                       Name of Corporation 
7. Check whichever is applicable

   1.     The corporation has members, those who will vote for the board of directors (see Section 33-31-140(23) of
          the 1976 S.C. Code of Laws, as amended).

   2.     The corporation does not have members.

8. If the corporation had been incorporated in South Carolina, it would have been (check “a”, “b”, or “c”, whichever is
applicable, (see Section 33-31-1706) of the 1976 S.C. Code of Laws, as amended).

   a.     Public benefit corporation.

   b.     Religious corporation.

   c.     Mutual benefit corporation.

9. The name and usual business address (with zip code) of the corporation’s directors (or those persons who exercise
the authority of directors if the corporation has no directors but has trustees or other similar positions), and the name
and   usual business addresses (with zip code) of the principal officers (or those who exercise such authority as officers
if the corporation does not designate officers):

   a. Directors:

   ____________________________________________________________________________________________ 
   (Name) 

   ____________________________________________________________________________________________ 
   (Business Address) 

   ____________________________________________________________________________________________ 
   (City, State, Zip Code) 

   ____________________________________________________________________________________________ 
   (Name) 

   ____________________________________________________________________________________________ 
   (Business Address) 

   ____________________________________________________________________________________________ 
   (City, State, Zip Code) 

   ____________________________________________________________________________________________ 
   (Name) 

   ____________________________________________________________________________________________ 
   (Business Address) 

   ____________________________________________________________________________________________ 
   (City, State, Zip Code) 

                                                     Form Revised by South Carolina Secretary ofOctoberState,  201 8
                                                                                                F0013 

                                                       Name of Corporation 
b. Principal Officers:

____________________________________________________________________________________________ 
(Name) 

____________________________________________________________________________________________ 
(Position) 

____________________________________________________________________________________________ 
(Business Address) 

____________________________________________________________________________________________ 
(City, State, Zip Code) 

____________________________________________________________________________________________ 
(Name) 

____________________________________________________________________________________________ 
(Position) 

____________________________________________________________________________________________ 
(Business Address) 

____________________________________________________________________________________________ 
(City, State, Zip Code) 

____________________________________________________________________________________________ 
(Name) 

____________________________________________________________________________________________ 
(Position) 

____________________________________________________________________________________________ 
(Business Address) 

____________________________________________________________________________________________ 
(City, State, Zip Code) 

Name of Corporation: 

Date: __________ 

BY: ____________________________________________________________________________________________
(Signature of Officer) 

 _____________________________________________________________________________________________ 
 (Print Name) 

 ___________________________________________________________________________________________
(Offi ec r Title) 

                        Form Revised by South Carolina Secretary ofOctoberState,  201 8
                                                                   F0013 

                                         FILING INSTRUCTIONS 

1.Include a  self-addressed stamped envelope to have a filed copy returned to you by mail.

2.If space on this form is insufficient, please attach additional sheets containing a reference to the          appropriate paragraph 
in this form.

3. This form must be accompanied by an original certificate of existence, or a document of similar import, duly 
authenticated by the Secretary of State or other official having custody of the corporate records in the State or country 
under whose law it is incorporated within thirty days of the date that it is received by the Secretary of State of South 
Carolina for filing.

4. If the applicant corporation is adopting a fictitious name for use in South Carolina pursuant to section 33-31-1506(a) of 
the 1976 S.C. Code of Laws, as amended, then a copy of the board of 

                                                       Form Revised by South Carolina Secretary ofOctoberState,  201 8
                                                                                                                F0013