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THE NORTH CAROLINA STATE
ANNUAL REPORT FOR REGISTERED PREPAID LEGAL SERVICES PLAN
The North Carolina State Bar requires, pursuant to 27 N.C. Admin. Code Chapter 1, Subchapter E,
§ .0307 of the North Carolina State Bar Regulations for Organizations Practicing Law, that each prepaid
legal services plan registered to operate in North Carolina submit a registration renewal every year. The
provisions of 27 N.C. Admin. Code Chapter 1, Subchapter E, § .0307 of the North Carolina State Bar
Regulations for Organizations Practicing Law hold that a prepaid plan may not continue to operate in
North Carolina if its annual renewal is not accepted by the North Carolina State Bar on or before
January 31 of each year.
Accordingly, this form and any accompanying documents must be completed and
submitted to the North Carolina State Bar no later than December 1 so that the application can be
reviewed and a determination made regarding its acceptance by the January 31 deadline.
Mail or email this report to:
Secretary of the North Carolina State Bar
c/o Savannah B. Perry, Deputy Counsel
North Carolina State Bar
PO Box 25908
Raleigh, NC 27611
Are there any changes you wish to make to your plan?
If “No,” please leave the rest of the document blank, save for the certification on page 3. If
“Yes,” please only complete the portions below that you wish to change this coming year.
Please note that if you wish to change any of the information listed below, you must
indicate it here and complete and file a separate amendment form.
1. New Name of Legal Services Plan:
2. New Name of Plan Sponsor:
3. New Name of Registered Agent of Plan or Entity Owning Plan in North Carolina:
4. New Name of Plan Administrator: