BUSINESS REGISTRATION DIVISION PO BOX 29622 RALEIGH, NC 27626-0622
(Revised August 2017) Form PLLC-01
Instructions for Filing
APPLICATION FOR CERTIFICATE OF AUTHORITY FOR A FOREIGN PROFESSIONAL LIMITED
LIABILITY COMPANY
(Form PLLC-01)
Item 1 Enter the complete name of the professional limited liability company (PLLC) exactly as it appears in the
records of the appropriate official in the state or country of formation. If the name cannot be used in
North Carolina, enter the name (including an applicable professional limited liability company ending)
that it wishes to use in North Carolina.
Item 2 Enter the state or country of formation.
Item 3 Enter the principal office address of the PLLC. Enter the complete street address of the principal office
and the county in which it is located. If mail is not delivered to the street address of the principal office or
if you prefer to receive mail at a P.O. Box or Drawer, enter the complete mailing address of the principal
office.
Item 4 Enter the mailing address of the PLLC’s principal office address if different than the street address listed
in item 3.
Item 5 Enter the complete street address of the PLLC’s registered office and the county in which it is located.
The registered office address must be located in North Carolina.
Item 6 Enter the complete mailing address, in North Carolina, of the PLLC’s registered agent, only if mail is not
delivered to the street address above or if you prefer to receive mail at a P.O. Box or Drawer.
Item 7 Enter the name of the registered agent. The registered agent must be a North Carolina resident, an
existing domestic business corporation, nonprofit corporation or limited liability company, or a foreign
business corporation, nonprofit corporation or limited liability company authorized to transact business or
conduct affairs in North Carolina.
Item 8 Enter the names, titles, and usual business address of the current principal company officials of the LLC.
Item 9 Attach a current Certificate of Existence or document of similar import with filing. The Certificate of
Existence cannot be more than six months old.
Item 10 If needed, a statement indicating a copy of the resolution of its managers adopting a fictitious name is
attached.
Item 11 Enter the specific personal services to be rendered by the limited liability company.
Item 12 Enter the name of at least one company official who is licensee of the applicable licensing board that
regulates the professional service that the PLLC renders.
Item 13 A certification from the applicable licensing board must be attached to the Articles of Organization. The
certification must be an original unless the licensing board permits electronic certification.
Item 14 The document will be effective on the date and at the time of filing, unless a delayed date or an effective
time (on the date of filing) is specified. If a delayed effective date is specified without a time, it will be
effective at 11:59:59 p.m. A delayed effective date may be specified up to and including the 90
th
day
after the day of filing.
Date and Execution
Enter the date the document was executed.
In the blanks provided enter:
The name of the limited liability company as it appears in Item 1.
The signature of the principal company official of the LLC executing the document.
The name and title of the above-signed principal company official.
