Please Answer All Questions & Provide Requested Information. Incomplete Applications Will Not Be Processed.

Entity Information

We, the undersigned, are applying as a:

Name of the Nonprofit Ministry, hereinafter referred to as "Entity":

Name of the Church, hereinafter referred to as "Entity":

Entity's Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is Mailing Address Same As Physical Address?(Required)

Entity's Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Federal Employer Identification Number (EIN)

By checking the box below, we request assistance in obtaining our EIN

EIN Assistance

Application Request For Nonprofit Ministry:

We, the undersigned officers of this Entity, do hereby make application to be an Affiliate of the International Congress of Churches & Ministers "ICCM" and authorize the same to include the Entity under its group exemption roster as an Affiliate of ICCM for the purpose of reporting to the Internal Revenue Service, and to be recognized as exempt under the ICCM 501(c)(3) Group Exemption.

Hereby Requested

Application Request For Church:

We, the undersigned officers of this Entity, do hereby make application to be an Affiliate of the World Church, Inc. - International Congress of Churches & Ministers ("World Church") and authorize the same to include the Entity under its group exemption roster as an Affiliate of World Church for the purpose of reporting to the Internal Revenue Service, and to be recognized as exempt under the World Church 501(c)(3) Group Exemption.

Hereby Agreed

Charter Application Requirements:

We understand and agree to pay any setup and/or processing fees applicable to this process, as specified by ICCM.

*Only required if assistance is needed in creating these Organizational Documents.

Group Exemption 501(c)(3) – $850

Articles Of Incorporation – $450*

Bylaws – $650*

We understand and agree to produce the following documents upon request by ICCM.

Mission Statement

Articles Of Incorporation: Copy of document filed and accepted by your State.

Bylaws: Copy of document with all of the Board of Directors' signatures on it.

Principal Officer/President must be licensed or ordained by ICCM and in good standing.

We understand and agree to the following rules as they apply to the Board of Directors ("Board"):

The minimum number of Directors required to comprise the initial Board is FIVE.

An address and original signature is required for all FIVE Directors of the initial Board.

Only TWO of the Directors can be related by blood or marriage.

The Principal Officer/President and the Treasurer cannot be related by blood or marriage.

Good Standing:

We understand that our exempt status shall remain in effect only as long as the Entity and the Principal Officer/President remain in good standing and meet all of the requirements, and that the exempt status can be revoked without notice upon failure to meet the agreed requirements.

Understood And Agreed

State Taxation:

We understand and agree that our acceptance as an Affiliate under ICCM or under World Church does NOT provide exemption from state taxation in the state wherein the Entity is domiciled; but upon approval of the Entity as an Affiliate, we may independently apply for exemption from state tax through the office of our Secretary of State.

Understood And Agreed

Tenets Of Faith:

We request acceptance from ICCM or World Church, as outlined in this Charter Application & Agreement, and agree to abide by the existing 22 Fundamental Truths and Constitutional Bylaws governing all members of ICCM. We further understand and agree that ICCM or World Church reserves the right to make changes or alterations to same at any time it may deem appropriate.

Understood And Agreed

Accounting & Reporting:

We agree to return a completed and notarized copy of our Annual Year End Financial Report (the form of which is mailed to us by ICCM or World Church in January) on or before March 15th annually. We understand that the annual accounting/reporting period for the Entity ends on December 31st each calendar year. If the Entity is in good standing and has met all requirements, an annual renewal fee of $250 will be assessed to renew the Affiliate standing with ICCM or World Church.

Understood And Agreed

Sovereign Entity:

We understand and agree that the Entity, upon approval as an Affiliate under ICCM’s 501(c)(3) Group Exemption or World Church's 501(c)(3) Group Exemption shall, at all times, remain a sovereign entity, complying with all applicable city, local, state, and/or federal regulations. We understand that this includes, but may not be limited to, those ordinances required by any other governing agency having jurisdictional authority in the state or municipality where the Entity is domiciled, and that compliance with all ordinances, laws, requirements, and controls shall, at all times, be the responsibility of the Entity.

Understood And Agreed

Indemnities:

We agree that the Entity herein indemnifies and holds harmless ICCM and World Church, their officers, representatives, employees, staff, and assigns from any and all damages, suits, liabilities, or actions, intentional or otherwise, that may arise as a direct or indirect result of the Entity's activities or accidents, of whatever kind or nature, regardless of the proximity to, or relationship with, the Entity.

Understood And Agreed

Acceptance:

We the undersigned officers, representing the Entity agree to all provisions specified herein, and acknowledge that any violation of this Agreement shall result in the immediate dissolution of the Affiliate charter granted by ICCM or World Church, at ICCM's or World Church's sole election and discretion, and to this we affix our signatures, attesting to same.

Understood And Agreed

Declaration:

By requesting application, we herein certify that, to the best of our knowledge, the mission, purposes, and activities of the Entity are of a religious and/or charitable nature and the Entity is not a private foundation. We hereby declare that each of the statements given or made in this application and supporting documents are correct and true; we solemnly pledge to abide by all promises and statements contained therein.

Understood And Agreed

Date:

Disclaimers:

Background checks are performed on all applicants. Please explain in advance any issues that would appear on these reports.
ICCM Bylaws and Our Fundamental Truths will be mailed upon successful completion of the application process. Our Fundamental Truths are online at www.iccmworldwide.org/about-us. It is your responsibility to review and abide by these documents.
We cannot guarantee medical coverage for individuals or small groups. Quotes are based on health and medical records obtained by our insurance department. Due to the confidential nature of this information, the ICCM Executive Offices does not review or process this information.
Christian Worker and General Member do not qualify for the position of Principal Officer/President.
If renewal fees are not paid on a timely basis, a late fee may be applied.
No refunds or credits will be issued.

BOARD OF DIRECTORS INFORMATION:

Initial Board of Directors:

Please complete the contact information for the Board of Directors below.
Each Director must sign electronically where indicated.
Only TWO Directors can be related by blood or marriage, and the Principal Officer/President and Treasurer cannot be related by blood or marriage.
Incomplete information or less than FIVE Directors will delay the application process.

Principal Officer/President

Name

First Last

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is The Principal Officer/President Mailing Address The Same As The Physical Address?

Mailing Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Electronic Signature

By signing (manually or electronically) the applicant understands that failure to abide by the Bylaws of and Scriptural interpretations by ICCM may result in credential revocation. Please sign electronically by placing your initials in between slash brackets. For example: /ABC/

Please Type Your Full Legal Name

Date

Vice President

Name:

First Last

Physical Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is The Vice President Mailing Address The Same As The Physical Address?

Mailing Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Electronic Signature

Please Type Your Full Legal Name

Date

Secretary

Name:

First Last

Physical Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is The Secretary Mailing Address The Same As The Physical Address?

Mailing Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Electronic Signature

Please Type Your Full Legal Name

Date

Treasurer

Name:

First Last

Physical Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is The Treasurer Mailing Address The Same As The Physical Address?

Mailing Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Electronic Signature

Please Type Your Full Legal Name

Date

Director

Name:

First Last

Physical Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is The Director Mailing Address The Same As The Physical Address?

Mailing Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Electronic Signature

Please Type Your Full Legal Name

Date

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