Individual Professional Solicitor Registration Statement Form - State Of South Carolina Secretary Of State Page 2
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3Period (Mo/Yr): ________________________________________________________________
5.
Are you authorized by any other state or local agency to solicit contributions for charitable or other
organizations?
[ ] YES [ ] NO
**If “YES”, what states and charitable organizations?
6.
Has your authority to solicit contributions been denied, cancelled, suspended or revoked ,or has any
disciplinary or legal action been taken against you by any governmental authority or is one pending in
relation to any fundraising activity?
[ ]YES [ ]NO
**If "YES", what action was taken? (Attach additional sheets if necessary)
7.
Have you ever been the subject of a criminal conviction whether the applicant, or its dirctors, principal
officers, individual owners, or partners has been the subject of a criminal convicition, including guilty or
nolo contendere pleas, involving any charitable solicitations act, fraud, dishonesty, or false statement in a
jurisdiction within the United States?
[ ]YES [ ]NO
** if “YES”, give a description of the conviction and date of conviction. (Attach additional sheets if
necessary)
Please read each of the following items. After reading each item, sign your initials in the space provided at
the left of each numbered item. Your application cannot be accepted unless you read and initial each item.
___ 8. The Solicitation of Charitable Funds Act requires that I, as a paid professional solicitor, disclose my status
as a professional or paid solicitor upon solicitation of any potential donor.
___ 9. The Solicitation of Charitable Funds Act requires that I, as a paid professional solicitor must disclose the
registered true name of the professional fundraising organization for which I work and the registered true
name, location, and purpose of any charitable organizations for which I am soliciting. The Solicitation of
Charitable Funds Act requires that upon request of the solicited party, that I, as a solicitor also must
disclose the percentage of gross receipts with which the professional solicitor is compensated including the
amount the professional solicitor must be reimbursed as payment for fundraising costs. I as a professional
solicitor also must disclose the guaranteed miunimum percentage of gross receipts to be remitted or
retained by the charitable organization excluding the amount which the charitable organization must pay
for fundraising costs.
___ 10. The Solicitation of Charitable Funds Act requires that I, as a professional solicitor upon oral or written
request by the solicited party, must deliver to the solicited party within fifteen business days of the request:
(1) a financial statement of the charitable organization disclosing assets, liabilities, fund balances, revenue
and expenses for the preceding fiscal year. The financial statement must be the most recently
submitted annual financial report pursuant to Section 33-56-60; and
(2) a copy of the professional solicitor’s or charitable organization’s current registration certification from
the Secretary of State.
___11. I understand that violation of one or more provisions of the law as set forth above may result in a
temporary or permanent injunction against my activities, administrative fines and may subject me to
criminal prosecution.
___12. I understand that copies of the Solicitation of Charitable Funds Act are available to me as well as all other
members of the public.
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