Domino's Pizza Enterprises Shareholder Class Action Form

Domino's Pizza Enterprises Shareholder Class Action

Registration Form
Complete this form if you would like to register your interest in the Domino's Shareholder Class Action.

It does not cost any money to register and you will never be 'out of pocket' as a result of participating in this class action.

If you have any questions, please contact us by email at enquiries@echolaw.com.au.
Please provide your contact details below*

First NameLast Name
Email*

Confirmation EmailPlease confirm email by re-entering in second box
Contact Number*
Address*

Street Address

Street Address Line 2

CityState

Post CodeCountry
Please confirm whether you agree to Echo Law's Privacy Policy*

I agree to Echo Law's Privacy Policy
Our Privacy Policy is available here.
Please verify that you are human*

Who are you registering on behalf of?*

MyselfMyself, jointly with other individualsSomeone elseA self-managed super fundA company or other corporate entityAn institution or claims aggregatorOther
Name of institution or claims aggregator*
What is the full name of the registered owner(s) of the shares?*
What is the ABN / ACN of the registered owner (if applicable)?
What is the SRN / HIN under which the shares were held?
Are the shares beneficially owned on behalf of someone other than the registered owner?*

YesNo
Who or what is the beneficial owner of the shares?*
If multiple beneficial owners, simply write "Multiple"

How many Domino's (DMP) shares did you, or the registered entity, hold at the close of trade on 17 August 2021?*
How many transactions in Domino's (DMP) shares did you, or the registered entity, make between 18 August 2021 to 3 November 2021?*

Please provide the details of all Domino's (DMP) transactions you, or the registered entity, made between 18 August 2021 to 3 November 2021?*
Have you provided the details of ALL DMP transactions you, or the registered entity, made between 18 August 2021 to 3 November 2021?*

YesNo
Please go back to the table above and enter details of all transactions entered into during the relevant period.

If you have more than 10 relevant transactions, you can provide the details of those transactions in a spreadsheet by changing your answer on the previous page.

Please upload all a record of all Domino's (DMP) transactions made between 18 August 2021 to 3 November 2021 using this template Excel spreadsheet.

If you have any questions, please contact us by email at enquiries@echolaw.com.au.
Upload transactions record:

Cancelof

Upload supporting documents:

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Please provide copies of any documents evidencing your transactions, such as contract notes, CHESS statements, off-market transfer forms, periodic transaction history statements and dividend confirmation statements.

If you don't have these documents readily available right now, please send them to enquiries@echolaw.com.au as soon as possible. If you don't provide these documents, we may contact you to verify your registration and follow up on any outstanding materials.
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