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Designation Of Registered Office Address And/Or Registered Agent (North Carolina)

This form is to register a corporate office and agent in North Carolina. The form provided here is simply a sample of what the actual Form BN-05 looks like.

State of North Carolina
Department of the Secretary of State

P. O. BOX 29622
RALEIGH, NC 27626-0622


Pursuant to §55-5-02, §55A-5-02, §55-15-08, and §55A-15-08 of the General Statutes of North Carolina, the undersigned corporation submits the following for the purpose of designating a registered office and/or registered agent in the State of North Carolina.

1. The name of the corporation is: ___________________________________

2. (Check if applicable). [___] The corporation currently has no registered office on file with the Secretary of State.

3. (Check if applicable). [___] The mailing address of the registered office is not on file with the Secretary of State.

4. The street address and county of the corporation's designated registered office is:

Number and Street: ___________________________________

City ___________________________________

State ___________________________________

Zip Code: ___________________________________

County: ___________________________________

5. The mailing address if different from the street address of the designated registered office is:


6. (Check if applicable). [___] The corporation currently has no registered agent on file with the Secretary of State.

7. The name of the designated registered agent and the designated registered agent's written consent to the appointment appears below:

___________________________________ (Type or Print Name of New Agent)

___________________________________ (Signature & Title*)

8. The address of the corporation's registered office and the address of the business office of its registered agent, as designated herein, will be identical

9. This statement will be effective upon filing, unless a date and/or time is specified:


10. This is the _____day of _______________, 20____.

__________________________________________ (Name of Corporation)

__________________________________________ (Signature)

__________________________________________ (Type or Print Name and Title)


1. Filing fee is $5.00. One executed statement and one exact or conformed copy of this statement must be filed with the Secretary of State.

2. This form is for use by corporations that have not filed the name of a registered agent or address of a registered office with the Corporations Division.

* Instead of signing here, the new registered agent may sign a separate written consent to the appointment, which must be attached to this statement.

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