STATE OF SOUTH CAROLINA 
                                 SECRETARY OF STATE 

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

Pursuant to §33-31-1504 of the 1976 S.C. Code of Laws, as amended, the undersigned nonprofit corporation hereby applies 
for an amended certificate of authority to transact business in the State of South Carolina, and for that purpose, hereby 
submits the following amendment: 

1. The name of the foreign nonprofit corporation is:

2. The nonprofit corporation received authority to transact business in South Carolina on: __________.

3. The application is filed for the following reason (complete all that apply):

a. The nonprofit corporation has changed its name as follows:

b. The nonprofit corporation has changed its duration to: ___________________________

c. The nonprofit corporation has changed the state or country of its incorporation to: ________________________

d. The nonprofit corporation has converted to: __________________________ 

4. The corporation is incorporated under the laws of: ___________________________
                                                    (State or Country) 

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

       a. Perpetual

       b. __________________________________________________________________________________

6. The registered office of the nonprofit corporation in South Carolina is:

_____________________________________________________________________________________________ 
(Street Address) 

_____________________________________________________________________________________________ 
(City, State, Zip Code) 

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

_____________________________________________________________________________________________ 
(Name) 

                                                    Form Revised by South Carolina Secretary of State, August 2016 
                                                                                                      F0117 

                                                                                   Name of Corporation 
 
7.  The principal office of the foreign nonprofit corporation is: 
 
 _____________________________________________________________________________________________ 
 (Street Address) 
  
 _____________________________________________________________________________________________ 
 (City, State, Zip Code) 
 
8.  Check whichever is applicable: 
 
         a.  The nonprofit corporation has members, those of whom will vote for the board of directors [see §33-
                  31-140(23) of the 1976 South Carolina Code of Laws, as amended]. 
                   
         b.  The corporation does not have members. 
  
9.  If the nonprofit corporation had been incorporated in South Carolina, it would have been one of the following, [check (a), 
 (b), or (c), whichever is applicable, as described in §33-31-1706 of the 1976 S.C. Code of Laws, as amended]: 
 
         a. Public benefit corporation. 
  
         b. Religious corporation. 
  
         c. Mutual benefit corporation. 
  
10.  The name and usual business address with zip code of the nonprofit 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 
  of officers if the corporation does not designate officers): 
 
  a.  Directors: 
  
  ____________________________________________________________________________________________ 
  (Name) 
  
  ____________________________________________________________________________________________ 
  (Business Address) 
  
  ____________________________________________________________________________________________ 
  (City, State, Zip Code) 
   
  ____________________________________________________________________________________________ 
  (Name) 
  
  ____________________________________________________________________________________________ 
  (Business Address) 
  
  ____________________________________________________________________________________________ 
  (City, State, Zip Code) 
  
                                                                  Form Revised by South Carolina Secretary of State, August 2016 
                                                                                                               F0117 
 

                          Name of Corporation 
   
  ____________________________________________________________________________________________ 
  (Name) 
  
  ____________________________________________________________________________________________ 
  (Business Address) 
  
  ____________________________________________________________________________________________ 
  (City, State, Zip Code) 
  
 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) 
  
                          Form Revised by South Carolina Secretary of State, August 2016 
                          F0117 
 

                                Name of Corporation 
   
 Date: __________ 
  
 Name of Corporation: 
  
 _____________________________________________________________________________________________ 
 (Signature of Officer) 
  
 _____________________________________________________________________________________________ 
 (Print Name)                   
 
 _____________________________________________________________________________________________ 
 (Office) 
 
 _____________________________________________________________________________________________ 
 (Telephone Number) 
 
                            Form Revised by South Carolina Secretary of State, August 2016 
                                F0117 
 

                                         FILING INSTRUCTIONS 
                                                      
1.  Two copies of this application, the original and either a duplicate original or a conformed copy, must be filed. 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 dated 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 directors’ (or equivalent governing body) 
  resolution approving the fictitious name certified by the secretary (or equivalent officer/position) must be attached to 
  this application. 
 
5.  This application must be accompanied by the filing fee of $10.00 payable to the Secretary of State. 
 
6.  Return to:  Secretary of State 
                Attn:  Corporate Filings 
                1205 Pendleton Street, Suite 525                                                                            
                Columbia, SC 29201 

                                                              Form Revised by South Carolina Secretary of State, August 2016 
                                                                                                                     F0117