Secretary Of The State Of Connecticut Application For Certificate Of Authority Foreign Corporation Page 5
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6INSTRUCTIONS
1. NAME OF CORPORATION IN STATE OR COUNTRY OF FORMATION: Please provide the name of the
corporation as it appears on the certificate of legal existence submitted with the application.
2. IF NAME PROVIDED IN NUMBER 1 ABOVE IS NOT AVAILABLE FOR USE IN CONNECTICUT, THE NAME
UNDER WHICH CORPORATION SHALL TRANSACT BUSINESS IN CONNECTICUT: If the corporation's name is
not available, please provide a name (which may be a fictitious name) that shall be used in the state of Connecticut
and which must be distinguishable from all other business names on record at the Office of the Secretary of the State.
3. CHECK EITHER A. OR B.: Place a check on the appropriate line to designate whether the corporation is organized for
profit or nonprofit.
4. STATE/COUNTRY OF INCORPORATION: Please provide the corporation's state or country of formation. Note: the
state or country, must match the state or country of incorporation indicated on the corporation's certificate of legal
existence.
5. DATE OF INCORPORATION: Please provide the complete date upon which the corporation was formed in its state or
country of incorporation. The date must be in the form of a month, day and year and must match the date of
incorporation presented on the corporation's certificate of legal existence.
6. DURATION: Please indicate whether the corporation has perpetual existence or has a limited duration by placing a
check mark next to the appropriate designation. Note: if a check mark is placed next to "OTHER", the corporation must
precisely specify the limit to its duration.
7. DATE CORPORATION BEGAN TRANSACTION BUSINESS/CONDUCTING AFFAIRS IN CONNECTICUT:
Please provide the exact month, day and year upon which the corporation began transacting business/conducting
affairs in Connecticut.
8. PRINCIPAL OFFICE ADDRESS OF THE CORPORATION: Please provide a complete street address of the
corporation's principal office including a street number, street name, city, state, postal code and country if other than
the United States. Note: P.O. boxes are only acceptable as additional information.
9. MAILING ADDRESS OF THE CORPORATION: Please supply an address, which may be a P.O. Box, to which the
Office of the Secretary of the State must mail all matter required or permitted to the corporation by either the Business
Corporation Act or the Revised Nonstock Corporation Act.
10. OFFICERS: Please provide the name of all of the corporation's officers, their titles and both addresses. Complete
street addresses including a street number, street name, city, state, postal code and country if other than the United
States are required. Note: P.O. boxes are only acceptable as additional information.
11. DIRECTORS: Please provide the name of all of the corporation's directors and both addresses. Include complete
street addresses, including a street number, street name, city, state, postal code and country, if other than the
United States are required. Note: P.O. boxes are only acceptable as additional information.
12. APPOINTMENT OF REGISTERED AGENT: The corporation may not appoint itself as its registered agent. The
corporation may appoint either the Secretary of the State by placing a check next to selection A or a natural person
who is a resident of Connecticut; a Connecticut corporation, limited liability company, limited liability partnership or
statutory trust; or a foreign corporation, limited liability company, limited liability partnership or statutory trust, which
has procured a certificate of authority to transact business in Connecticut by completing item B.
Please note the following: if the agent being appointed is a natural person that person's business address must be
provided under the heading Business/registered office address and their residence address under the heading
Residence address; if the agent appointed is an entity, it must provide its principal office address under the
business/registered office address heading; the agent must sign accepting the appointment in the space provided; the
signatory must print their name & capacity under which they sign if signing on behalf of an entity and all addresses
must include a street number, street name, city, state, postal code.
FORM CFAS-1-1.0
DO NOT SCAN THIS PAGE
INSTRUCTIONS
Rev. 8/2012
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