THB100,000 (VAT exclusive) payable in the form of: [ ] [ ] - Bank draft / Corporate cheque / Cash - Receipt of money transfer [ ] 8. Other supporting documents (please specify
[ ] Executive (please specify title in the company) Date of Appointment : Part 1 : General Information 1.1 First name / Last name (in Thai) : Title First Name Last name First name / Last name (in English) : Title
the applicant ( Mr. ( Ms. ( Mrs. ( Others (please specify
(UNOFFICIAL TRANSLATION) (Updated 2017) 2. Background and Details of Applicant Requesting Approval 1. First and last name of the applicant Mr. Ms. Mrs. Others (please specify
Securities company Foreign Securities company Big lot (please specify the name(s) of parties executing the transaction with the reporting person (if known)) ( ) Direct sale/purchase (please specify the name(s
specify) Full name as per Passport Date of birth (DD/MM/YYYY) Passport number Identification number Country of issue of Passport CPA license number Issued by Country Home address City State Postcode Country
to securities business Others (Please specify): ................................................................................................................... Foreign juristic person (Please
Director [ ] Independent Director and Member of Audit Committee Executive [ ] Executive (please specify title in the company) Date of Appointment : Part 1 : General Information 1.1 First name / Last name (in
investor. Please specify the name of the intermediary / financial advisor ……………………………………………………………………………………………………………………….. Director. Please specify the name of the listed company / issuer