).............................................. ............................ ............... ………………… (For further details, please attach herewith) 6. Address No........................... Building / Residence: ........................... Alley: ......................... Road

, Thailand 333/3 Vibhavadi-Rangsit Road, Chomphon, Chatuchak Bangkok 10900, Thailand Tel. +66 1207 or +66 2695 9587 Fax. +66 2695 9793 e-mail : oca@sec.or.th 1. Applicant details Mr. Miss Mrs. Other (please

333/3 Vibhavadi-Rangsit Road, Chomphon , Chatuchak Bangkok 10900, Thailand Tel. +66 1207 or +66 2695 9587 Fax. +66 2695 9793 e-mail: oca@sec.or.th 1. Applicant details Mr. Miss Mrs. Other (please

appeared in the census registration: Address No. …….………... Moo No. ………….... Trok/Soi ………......…. Road …………….... Tambol/Subdistrict …………... Amphur/District ……. Province …………… Postal code ……..…….. Telephone

/ Soi Road Sub-district District Province Zip Code Country Tel. Fax. E-mail Overseas Address : (only for a non-Thai national, please specify overseas contact address) 1.6 Academic Background Highest

UNOFFICIAL TRANSLATION 2 Office of the Securities and Exchange Commission 333/3 Viphavadi-Rangsit Road, Chomphon Subdistrict Chatuchak District, Bangkok 10900 www.sec.co.th Tel: 0-2033-9999 Fax: 0

following businesses: (a) rail or pipe transportation system; (b) electricity; (c) water supply; (d) road, toll road or concession road; (e) airport; (f) deep sea port; (g) telecommunication or information