Application for registration with regulatory agency

Application for registration with regulatory agency. Application for Issuance of Certificate of Registration as a _________[e.g., Law] Corporation 1. _________(name of applicant), a professional corporation, requests issuance to it of a certificate of registration as a _________[e.g., law] corporation. 2. A. The address of applicant's principal office is: _________. B. The addresses of all other offices of applicant are: _________. 3. Applicant files here, in support of its above request, the following: A. Copy of its articles of incorporation, certified by the secretary of state. B. List of the names and addresses in alphabetical order: (1) of each of its directors, officers and shareholders, on which is noted (a) any officer who is not an active _________[e.g., member of the state bar] and (b) those directors, officers and shareholders who will _________[e.g., practice law] on its behalf, and (2) other employees of applicant who will _________[e.g., practice law] on its behalf. C. A statement that its name or names under which it may practice law contains and is restricted to the name or to the last name of one or more of the present, prospective, or former shareholders or of persons who were associated with a predecessor person, partnership, or other organization or whose name or names appeared in the name of such predecessor organization, and that the name includes wording or abbreviations denoting corporate existence such as "Professional Corporation," "Prof. Corp.," "Corporation," "Corp.," "Incorporated," or "Inc." D. A copy of those portions of its bylaws, or a reference to the provisions of its articles of incorporation, relating to (i) ownership of its stock pursuant to _________[statutory or rule citation], (ii) transfer of its stock upon occurrence of the events set forth in subsection (2) of _________[statutory or rule citation], (iii) the placing of a legend on its share certificates pursuant to _________[statutory or rule citation] and (iv) the prohibition of the distribution of income pursuant to _________[statutory or rule citation]. E. Certificate of insurance evidencing insurance for the purpose and in the amounts required by _________[statutory or rule citation], or executed copy of written agreement of guarantee provided for in _________[statutory or rule citation]. F. A declaration that the applicant is an existing corporation and that its organization, bylaws, articles of incorporation and general plan of operation are such that its affairs will be conducted in compliance with the _________[e.g., State Bar Act, the Professional Corporations Act and other applicable provisions of the Corporations Code, the Rules of Professional Conduct of the State Bar, Law Corporation Rules of the State Bar] and such other law, rules and regulations as may be applicable. G. A filing fee in the amount of $_____. Executed [Date]. _________[Name of Corporation] By _________[Print] _________[Title] _________[Signature] Declaration I am an officer of _________(name of applicant), and as such make this declaration for and on behalf of the corporation. I have read the above application and all attachments to it and know the contents of it, and the same are true of my own knowledge. I declare, under penalty of perjury, that the above statements are true and correct. Executed on [Date], in the _________, state of _________.