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Application For Certificate Of Authority Foreign Non-Profit Corporation - Government Of The District Of Columbia

DEPARTMENT OF CONSUMER AND REGULATORY AFFAIRS

BUSINESS AND PROFESSIONAL LICENSING ADMINISTRATION

CORPORATIONS DIVISION

941 NORTH CAPITOL STREET, N.E.

WASHINGTON, D.C. 20002

Government

of the

District of Columbia

APPLICATION FOR CERTIFICATE OF AUTHORITY

FOREIGN NON-PROFIT CORPORATION

To:

Department of Consumer and Regulatory Affairs

Business and Professional Licensing Administration

Corporations Division

941 North Capitol Street, N.E.

Washington, D.C. 20002

Pursuant to the provisions of the Code of Laws for the District of Columbia and the

NON-PROFIT

CORPORATION ACT (D.C. Code, 2001 edition, Title 29, Chapter 3), the undersigned

corporation hereby applies for a Certificate of Authority to conduct its affairs in the

District of Columbia, and for that purpose states as follows:

1. Name of Corporation:____________________________________________________

2. Incorporated under the laws of the State/County of : ___________________________

3. Date of Incorporation: _________________

4. Term of Existence (Perpetual or Specified Period): ____________________________

_______________________________________________________________________.

5. Date commenced or will commence conducting affairs in the District: ____________

6. Address (including street and number) of its principal office in the State/County where

organized: ______________________________________________________________

________________________________________________________________________

7. Address (including street and number) of its proposed registered office in the District:

________________________________________________________________________

8. Name of its proposed registered agent at such registered office address:

________________________________________________________________________

9. Brief statement of activities and affairs it proposes to conduct in the District:

________________________________________________________________________

Application For Certificate Of Authority Foreign Non-Profit Corporation - Government Of The District Of Columbia