Division 4 ADDRESSEE

1. 4.1.

   Identity:

   1. 4.1.1.

      Date of birth, if available:

These items are optional when a copy of the request for service of documents is attached:

1. 4.2.

   Address:

   1. 4.2.1.

      Street and number/PO box:

   2. 4.2.2.

      Place and postcode:

   3. 4.2.3.

      Country:

2. 4.3.

   Tel. ^f1:

3. 4.4.

   Fax :

4. 4.5.

   Email :

5. 4.6.

   Identification number/social security number/organisation number/or equivalent :

6. 4.7.

   Any other information relating to the addressee :

Done at:

Date:

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