Division 3 ADDRESSEE

1. 3.1.

   Identity:

2. 3.2.

   Last known address:

   1. 3.2.1.

      Street and number/PO box:

   2. 3.2.2.

      Place and postcode:

   3. 3.2.3.

      Country:

3. 3.3.

   Known personal details of the addressee (if natural person), if available:

   1. 3.3.1.

      Name at birth:

   2. 3.3.2.

      Other known name(s):

   3. 3.3.3.

      Date and place of birth:

   4. 3.3.4.

      Identification number/social security number/or equivalent:

   5. 3.3.5.

      Mother’s or father’s name at birth:

   6. 3.3.6.

      Other information:

4. 3.4.

   Known details of the addressee (if legal person), if available:

   1. 3.4.1.

      Registration number or equivalent:

   2. 3.4.2.

      Name(s) of the member(s) of the board/representative:

5. 3.5.

   Tel. ^f1:

6. 3.6.

   Fax :

7. 3.7.

   Email :

8. 3.8.

   Other information, if available:

Done at:

Date:

Signature and/or stamp or electronic signature and/or electronic seal: