COMMONWEALTH OF VIRGINIA STATE CORPORATION COMMISSION SCC632/831 APPLICATION FOR REGISTRATION OR FOR (07/05) RENEWAL OF REGISTRATION OF CORPORATE NAME Note: This form is for use by foreign corporations only. Pursuant to the provisions of 13.1-632 or 13.1-831 of the Code of Virginia, the undersigned foreign corporation applies for (mark appropriate box): registration of its corporate name renewal of registration of its corporate name Name of foreign corporation:________________________________________________________ If applicable, name of corporation with any addition required by 13 .1-762 B 1 of the Code of Virginia: ________________________________________________________________________ _______ Address: ___________________________________________________________________ State or country of incorporation: _________________________________________________ Date of incorporation: _______________________________________________________ Nature of corporations business: _________________________________________________ ________________________________________________________________________ _______ It is a Class 1 misdemeanor for any person to sign a document he or she knows is false in any material respect with intent that the document be delivered to the Commi ssion for filing. The undersigned executes this application in the name of the corporation : ______________________________ ___________________________________________ (signature) (printed name and corporate title) If different from above: Correspondents name: _______________________________________________________ Correspondents address: _______________________________________________________ _______________________________________________________ Correspondents telephone number (optional): ( _______ ) ____________ - ______________ FOR SCC USE: DCN: Expires: Registration #: See instructions on the reverse American LegalNet, Inc. www.USCourtForms.com>>>> 2 INSTRUCTIONS The application must be in the English language, typewritten or printed in black, legible and reproducible. The document must be presented on uniformly white, opaque paper, free of visible watermarks and background logos. You can download this form from our website at www.scc.virginia.gov/division/clk/fee_bus.htm. The corporate name must be distinguishable upon the records of the Commission. See 13.1-63 0 of the Code of Virginia for a stock corporation and 13.1-829 of the Co de for a nonstock corporation. To check the availability of a corporate name, please contact the Clerks Office C all Center at (804) 371- 9733 or toll-free in Virginia at (866) 722-2551. If the real name of a foreign stock corporation does not satisfy the requirements of 13.1-762 A 1 of the Code of Virginia, it shall adopt a designated name for use in this Commonwealth. See 13.1-762 B 1 of the Code of Virginia. The application must be executed in the name of the corporation by the chairman or any vice-chairman of the board of directors, the president, or any other of its officers authorized to act on behalf of the corporation. For registration and for renewal of a corporate name, the application must be accompanied by a certificate setting forth that the foreign corporation is in good standing, or a document of similar im port, from the state or country of incorporation, executed by the official who has custody of the records pertaining to corporations. For registration of a corporate name, the application must be accompanied by payment of the REGISTRATION FEE in the amount of $20.00. A registration is effective for one year after the date an application is filed. For renewal of the registration of a corporate name, the application must be filed during the 60-day period preceding the date of expiration of the registration and must be accompanied by the RENEWAL FEE of $20.00. A renewal is effective for one year after the date the registration would have expired. Submit the original, signed application and the certificate to the Clerk of the State Corporation Commission, P.O. Box 1197, Richmond, Virginia 23218-1197, (Street address: 1300 East Main St reet, st Tyler Building, 1 Floor, Richmond, Virginia 23219), along with a check for the filing fee in the amount of $20.00, payable to the State Corporation Commission. PLEASE DO NOT SEND CASH . If you have any questions, please call (804) 371-9733 or toll-free in Virginia, 1- 866-722-2551. NOTE This form is for use by foreign corporations, which are those organized under the laws of a jurisdiction other than Virginia. A registered name can be released by filing a notice of release of a registered name with the Commission, accompanied by a check in the amount of $10.00 made payable to the State Corporation Commission. The notice must be signed on behalf of the corporation whos e registered name is being released. American LegalNet, Inc. www.USCourtForms.com