Domicile Change Form

DOMICILE CHANGE FORM

This Domicile Change Form is entered into by and between the parties listed below for the purpose of effecting a change of domicile record and related administrative actions. Applicant Name: and Organization Name: . Effective Date of Request:

WHEREAS

1. WHEREAS, Applicant represents that Applicant is currently domiciled at and seeks to have Organization update its records to reflect a new domicile at .

2. WHEREAS, Organization maintains official records of Applicant's domicile for purposes of administration, notices, and regulatory compliance and is authorized to make such updates upon receipt of required documentation and applicable fees.

3. WHEREAS, the parties desire to record the scope, processing requirements, fees, and other terms governing the domicile change, as set forth below.

SCOPE OF CHANGE

PAYMENT TERMS

Applicant agrees to pay Organization the processing fee and any applicable administrative charges in exchange for the services described in the Scope of Change. The payment terms are set forth below and constitute a binding obligation of Applicant.

All fees are non-refundable except as expressly provided in this form. Organization may suspend processing until payment is received in full. Applicant remains responsible for all fees and costs reasonably incurred to effect the domicile change.

TERM AND TERMINATION

This Agreement commences on Start Date: and continues until End Date: , unless earlier terminated in accordance with the terms below.

Either party may terminate for material breach if the breaching party fails to cure within the notice period. Termination does not relieve Applicant of payment obligations accrued prior to termination, nor does it affect Organization’s rights to retain fees for services already performed.

CONFIDENTIALITY

Each party shall maintain as confidential all non-public information received from the other party in connection with the domicile change, including identity documents, proofs of residency, and any financial information (Confidential Information). Confidential Information shall not be disclosed except (a) with the disclosing party's prior written consent, (b) to personnel or contractors on a need-to-know basis who are bound by confidentiality obligations no less protective than those herein, or (c) as compelled by law or valid legal process, provided that the receiving party gives prompt notice when permitted so the disclosing party may seek protective relief.

CERTIFICATION AND REPRESENTATIONS

Applicant certifies that the new domicile information provided is true, accurate, and complete. Applicant acknowledges that knowingly providing false domicile information may subject Applicant to administrative penalties and legal liability. Applicant further represents that Applicant has authority to request the domicile change and to authorize Organization to update its records as described herein.

ATTACHMENTS AND VERIFICATION

The following supporting documents are required to verify the domicile change. Applicant must provide at least one primary document unless otherwise agreed in writing.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the jurisdiction selected below. The parties consent to the exclusive jurisdiction and venue of state and federal courts located in that jurisdiction for any dispute arising out of or relating to this Agreement.

ENTIRE AGREEMENT

This document, together with any attachments or exhibits expressly incorporated by reference, constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior and contemporaneous agreements, representations, and understandings, whether written or oral. Any modification must be in a writing signed by both parties.

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