Delaware Division of Corporations 
                           401 Federal Street – Suite 4 
                           Dover, DE 19901 
                           Ph: 302-739-3073 
                           Fax: 302-739-3812 
                                              
                                                                      Qualification 
                                                              of Foreign Corporation 
                                                                                          
Dear Sir or Madam:  
 
       Attached please find a form for a Qualification of a Foreign Corporation to be filed in 
accordance with Section 371 of the General Corporation Law of the State of Delaware. A 
Certificate of Existence, dated within six months prior to the filing of the Qualification 
Certificate, from the foreign corporation’s jurisdiction of incorporation must be submitted 
with the Qualification Certificate.  The fee to file the Qualification Certificate is $245.  You 
will receive a stamped “Filed” copy of the submitted document along with a certificate of 
Qualification issued by the Secretary of State. A certified copy may be requested for an 
additional $50. Expedited services are available. Please contact our office concerning these 
fees or you may consult our fee chart at www.corp.delaware.gov.  Please make the check 
payable to “Delaware Secretary of State”. 
        
       An Annual Report must be filed by the foreign corporation by June 30 of each 
year following the calendar year in which their Qualification Certificate becomes 
effective.  The fee to file the Annual Report is $125.  Please contact the Franchise Tax 
Section with any questions regarding the filing of the Annual Report. 
         
       For the convenience of processing your order in a timely manner, please include a 
cover letter with your name, address and telephone/fax number to enable us to contact you if 
necessary. Please make sure you thoroughly complete all information requested on this form. 
It is important that the execution be legible, we request that you print or type the name of 
the person signing under the signature line. 
 
       Thank you for choosing Delaware as your corporate home. Should you require 
further assistance in this or any other matter, please don’t hesitate to call us at (302) 739-
3073.  
 
 Sincerely,  
 
                                              Department of State  
 Division of Corporations 
 encl. 
 rev. 03/11 
 

Special Instructions – Qualification Certificate of a Foreign 
Corporation 
 
This form is to be used as a Template only. The following instructions will 
help you in correctly completing your Qualification Certificate.  The 
instructions are numbered to correspond with the article being referenced. 
 
 1.  The name of the foreign corporation.  If the name under which they 
    are incorporated is not available for use in Delaware please choose a 
    new name and list it as follows after the true name” doing business 
    under the assumed name of ……”.  Please visit our website to verify 
    name availability. 
 2.  The jurisdiction of incorporation for the foreign corporation. 
 3. The specific purpose of the foreign corporation must be listed; a 
    general purpose statement is not sufficient. 
 4. List the complete name and street address of the registered agent 
    located in Delaware you are appointing to accept service of process 
    for the foreign corporation. 
 5. List the assets and liabilities of the foreign corporation within 6 
    months prior to the filing of this certificate.  If the foreign corporation 
    has no assets or liabilities please list “0” in the appropriate places. 
 Execution Block - The document must be signed by an authorized officer 
    of the foreign corporation pursuant to Section 371 of Title 8.  The 
    name of the person must be typed or written legibly underneath the 
    signature. 
  
 PLEASE NOTE:  The completed qualification certificate must be 
    accompanied by a Certificate of Existence, dated within 6 months 
    prior to the filing of this certificate, from the foreign corporation’s 
    jurisdiction of incorporation.  If such certificate is in a foreign 
    language an English translation must be attached. 
 
This form contains the basic information required by statute; if you need to 
add additional information permitted by statute you may draft a new 
document.  Please feel free to call our office at 302-739-3073 for assistance 
in completing this form. 
 
Sincerely, 
Delaware Division of Corporations 

            STATE OF DELAWARE 
            QUALIFICATION CERTIFICATE 
             OF A FOREIGN CORPORATION 
  
 The foreign corporation hereby certifies as follows: 
  
 1.  The name of the foreign corporation is  
   
 2.  The foreign corporation is formed under the laws of  
                                           and is filing herewith a certificate evidencing its corporate 
 existence. 
  
 3.  The business which it proposes to do in the State of Delaware is as follows: 
  
 4.  The Registered Office of the foreign corporation in the State of Delaware is 
 located at                                                                                                                  (street), 
 in the City of                                                               , Zip Code                                      
 The name of the Registered Agent at such address upon whom process against this 
 foreign corporation may be served is  
                                                                                                                                              
 5.  The assets of said foreign corporation are $                                                   and the 
 liabilities thereof are $                                       .  The assets and liabilities indicated are as 
 of a date within six months prior to the filing date of this Certificate. 
  
 6.  The business which it proposes to do in the State of Delaware is the business it is 
 authorized to do in the jurisdiction of its incorporation. 
  
                   By: 
                                                     Authorized Officer 
             
              Name: 
                                                            Print or Type