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

ownership of, the possessory right or the leasehold in land, building, construction, machine, equipment including all other related assets used in the operation of an infrastructure business; (b) the

_______ Country _______ Expiry date _______ Home Address _______ City State Postcode Country E-mail address Telephone number Fax number Mobile phone number 2. Principal place of practice Firm Name Position

Thailand; (3) an international financial institution; (4) a juristic person established under a specific law; (5) a government agency and a State enterprise under the law on budgetary procedure; (6) the

(company) (* The registration statement shall be signed either by a CIS Operator or an authorised person of the CIS Operator. The person who signs shall state his/her full name and capacity and shall ensure

) _________________________________________ (company) (* The registration statement shall be signed either by a CIS Operator or an authorised person of the CIS Operator. The person who signs shall state his/her full name and capacity and

signs shall state his/her full name and capacity and shall ensure the declaration is dated.) Form updated as of June 2021 Name of foreign collective investment scheme (CIS): Home jurisdiction: Name of

securities company; or (b) an appointment is made in accordance with Section 145; (c) the securities company is a state enterprise under the law relating to budget procedures. (8) being a manager or a person

government agency and state enterprise under the law on budgetary procedure; (8) the Financial Institutions Development Fund; (9) a juristic person having total assets of five hundred million baht or more

assets 9. Property, plant and equipment 10. Intangible assets 11. Other assets Total assets Liabilities and shareholders’ equity (Unit:Baht) Consolidated The Company only ( 20..) ( 20..) (20..) (20