:………………………………….. Nationality:……………………………………….. Email:…………………………………..Telephone Number:………………………………. Address

Capital Tower All Seasons Place 87/1 Wireless Road Bangkok 10330 Telephone (66) 2305 8000 Facsimile (66) 2305 8010 www.linklaters.com Prepared by: Wilailuk Okanurak Telephone 66 2305 8024 wilailuk.okanurak

: ………………………………………………………………………………………………………. Telephone No. : ………………………… Mobile No. : ……………………… Fax : ……………..………. Address

Reference ID Char(13)* 13 M เลขที่ Reference 3234567890123 Account ID Char(10) 10 M เลขทะเบียนผู้ถือหุ้น 0000000012 Shareholder Type Char(1) 1 M ประเภทบุคคล 0 = Thai Juristic 1 = Thai individual 2 = Foreign