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

_______ 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

; “State agency” means central administration, regional administration, local administration, financial institutions development fund, Bureau of Crown Property and other agency as specified by the Office

securities sold is less than the minimum amount specified by the issuer, the reasons for the cancellation of the offer for sale, and the securities subscription, etc.) - State the warning statement for

established under specific law which are not persons under (9); (7) Bank of Thailand; (8) International financial institutions; (9) Government agencies and state enterprises under the laws on budgetary

for transactions, requirement to obtain approval from or report to senior management, face-to-face contact with the client or his ultimate beneficial owners or ultimate controlling persons, assessment

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