license and evidence on renewal of such license; (11) Copy of Identification Card; (12) Copy of the Shareholders Name List (Form Bor. Or. Jor. 5). In this regard, I confirm my willingness to provide

indicating such change) 1.2 Type of Card [ ] Identification Card [ ] Passport (only for non-Thai national who does not have an identification card or does not know identification number) Card Number : Expiry

statement that ought to be declared. In this regard, as evidence that each and every page of the documents is of the exact documents to which I/we have certified, I/we have hereby signed my/our initial or

of the documents is of the exact documents to which I/we have certified, I/we have hereby signed my/our initial or signature on each and every page of the documents and the amendments thereto

nor omission of any material statement that ought to be declared. In this regard, as evidence that each and every page of the documents is of the exact documents to which I/we have certified, I/we have

this regard, as evidence that each and every page of the documents is of the exact documents to which I/we have certified, I/we have also signed my/our initial or signature on each and every page of the

client’s true identity (client identification), including the identity of the ultimate beneficial owner and the controlling person of the transactions; (2) verify the client’s identity using reliable sources

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

regard, as evidence that each and every page of the documents is of the exact documents to which I/we have certified, I/we have also signed my/our initial or signature on each and every page of the

and specifying exact time when the report would be able to be submitted. In case the SEC Office determines that such request is necessary and appropriate, the SEC Office may render a waiver for such