Application For Certification And Registration Of A Professional Corporation With The North Carolina Medical Board

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Application for Certification and Registration of a
Professional Corporation with the North Carolina Medical Board
Paper Application with payment by check
Please note that all applications initiated and paid for by MasterCard or Visa online will receive priority
processing.
To file for registration and certification with the North Carolina Medical Board (NCMB) you are required
to send the following four items:
1. A notarized NCMB PC-01 form, Certificate of Incorporators (form enclosed)
2. Professional Corp/LLC Address Form (form enclosed)
3. The applicable original form listed below completed and signed by a NCMB licensee.
(Forms available from the NC Secretary of State)
Articles of Incorporation for a Professional Corporation
Articles of Conversion to a Professional Corporation Amendment and supporting documentation
duly authenticating existence from the state of NC
Application for Certificate of Authority Foreign Professional Corporation and supporting
documentation duly authenticating existence from the state of incorporation
4. Check payable to the North Carolina Medical Board for the application fee of $50.
A NCMB licensee may apply for Certification and Registration of a professional corporation from NCMB. Once
documents are submitted, and the Board has determined that all statutory requirements are met, NCMB will return
the original Articles to you along with the Certification (NCMB PC-02) and Registration Certificate (NCMB PC-
03)
• Send the original applicable state form with the Board’s seal, Certificate (NCMB PC-02), and required
Secretary of State (SOS) fee to the NC SOS.
The NCMB will verify with NC SOS that your business has submitted a Creation Filing. Creation Filing with NC
Secretary of State (“SOS”) must be completed within four months of the NCMB Certificate issued date.
Unfiled certificates will expire after four months. If certification expires, reapplication will be required
before filing with the SOS.
Please Note:
Professional businesses registered with NCMB are required to maintain with the Corporations Department up to
date information concerning address, registered agent, shareholder or member changes, acquisitions, mergers,
and closings/dissolutions. For your convenience the Board provides a “Guide for Professional Corporations
and Professional Limited Liabilities Companies,” which outlines the procedures for maintenance of registration
as a Professional Corporation or Professional Limited Liability Company.
All NCMB professional businesses are required to renew their registration. The registration expiration date is
found on the registration certificate. Notification for renewal during the fourth quarter of the renewal year due will
be sent to the business’ address on file with the NCMB. Failure to renew your registration will be cause for
suspension under State Statute NCGS 55B-13.

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