Domicilium Citandi et Executandi

Domicilium Citandi et Executandi
I, the undersigned hereby confirm the following address, contact number and e-mail address as my domicilium citandi et executandi for all correspondence from my employer. I nominate the use of my e-mail address as my primary method of communication from the company. I acknowledge that it is my responsibility to inform my employer of any changes in my domicilium citandi et executandi and understand that any communication/letters sent by the company to an outdated address is deemed as received.
NAME*
SURNAME*
ID NUMBER*
EMPLOYEE NUMBER*
UNIT NUMBER
BUILDING NAME
STREET NUMBER*
STREET NAME*
SUBURB/TOWNSHIP*
CITY*
POSTAL CODE*
CONTACT NUMBER*
E MAIL ADDRESS*
example@example.com
SIGNATURE*

Clear
DATE*

DayMonthYear
Date
Should be Empty: