Application for Certificate of Registration for a
Professional Corporation/Professional Association
The undersigned, being all of the incorporators of ___________________________________________,
a professional corporation (“PC”) to be incorporated under the laws of the state of North Carolina for the
purpose of practicing law, hereby certify to the Council of the North Carolina State Bar:
1. At least one person who is an incorporator, at least one person who will be an original officer, and at least
one person who will be an original director, and all persons who, to the best knowledge and belief of the
undersigned, will be original shareholders and/or employees who will practice law for said PC in North
Carolina are duly licensed to practice law in the State of North Carolina. The names and addresses of such
persons are (attach additional sheets as necessary):
Name and Position Address Phone Email
(incorporator, officer, director,
Shareholder, employee)
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
2. Each original shareholder who is not licensed to practice law in North Carolina but who will perform
services on behalf of the PC in another jurisdiction in which the PC maintains an office is duly licensed to
practice law in that jurisdiction. The names, addresses, and license information of each such person are:
Name Address Jurisdiction of License
Licensure Number
________________________________________________________________________________________
________________________________________________________________________________________
“Professional Corporation (PC)” is used throughout this document to refer to both professional associations and
professional corporations.
Revised March 2018