E-mail address Telephone number Fax number Mobile phone number 2. Principal place of practice Firm Name Position in the firm Address City State Postcode Country E-mail address Telephone number Fax

_______ 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

number, mobile phone number or e-mail of which companies shall update a name list and contact information regularly. Additionally, companies should specify additional communication channels, such as SMS

objective in undertaking fund management business for short and long term. Objective should be set for the short-term plan and criteria/factor for evaluation of the accomplishment of the plan should be

position; (6) Fees charged on the derivatives transaction. Clause 4. Derivatives broker must show in the evidence of margin call at least the information as set out under Clause 3(1) and (3) as well as the

preparation and submission of daily status report in text file via OFAR Version 1.7 Intermediaries Supervision Policy Department Telephone: 0-2263-6257 Facsimile: 0-2263-6487

charged on the derivatives transaction. Clause 4 A derivatives broker shall at the minimum include the information as set out under Clause 3(1) and (3) as well as the following information on the evidence

comply with the requirements accordingly. Sincerely -signature- (Mr. Vorapol Socatiyanurak) Secretary-General Intermediaries Supervision and Development Department Telephone: 0-2263-6255 Fax: 0-2263-6446

: Type of Business: __________________________ Head Office: __________________________________________________________________ Registration Number: Home Page (if any): ________________________ Telephone

: ......................... Sub-district: ................. District: ...................... Province: .................. Telephone: ................................................... Facsimile