Declaration of Residence

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

DECLARATION OF RESIDENCE

I, {{employee_full_name}}, Employee ID: {{employee_id}}, hereby declare that my current and permanent residential address is as follows:

Residential Address Details

Street Address: {{street_address}}

Apartment/Suite/Unit: {{apartment_suite_unit}}

City: {{city}}

State/Province: {{state_province}}

Postal Code: {{postal_code}}

Country: {{country}}

Previous Address (If Applicable)

My previous residential address was (if moved within the last 12 months):

Street Address: {{previous_street_address}}

Apartment/Suite/Unit: {{previous_apartment_suite_unit}}

City: {{previous_city}}

State/Province: {{previous_state_province}}

Postal Code: {{previous_postal_code}}

Country: {{previous_country}}

Date of Move: {{date_of_move}}

Purpose of Declaration

This declaration is made for the purpose of updating my official records with {{company_name}}, for tax compliance, and for all other official correspondence requiring my residential address.

I understand that it is my responsibility to notify {{company_name}} immediately of any change in my residential address.

Affirmation and Accuracy

I hereby affirm that the information provided above is true, accurate, and complete to the best of my knowledge and belief.

I understand that providing false or misleading information may lead to disciplinary action, including termination of employment, and may have legal consequences.

Acknowledgement

By signing below, I acknowledge and confirm the accuracy of the residential address information provided.

Signature Block

_____________________________

{{employee_full_name}}

Employee ID: {{employee_id}}

Date: {{date}}

For Company Use Only

Received By: _____________________________

Name: {{receiver_name}}

Position: {{receiver_position}}

Date: {{receipt_date}}

Signature: _____________________________