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

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

_______ 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

interest of the business and all shareholders. Such descriptions should enhance investors’ understanding of the overall business operation the Company or the group of companies. 2. Nature of business In case

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

years; 1.1.5 Name and location of the head office, type of business, company registration number, telephone number, facsimile number, the Company’s website (if any), the number and type of the total

) ………………………………………………………… Location of head office ……………………………………………………………… …………………………………………………………………..…………………… Telephone number …………………….. Facsimile number ……………………….. Part 2: Category of an applicant □ A commercial bank under the

…………................................................................. …………………………….......................................................................... telephone number…………………….. facsimile number ………………………… 2. Details for supplementing the consideration: 2.1 A license granted by the authorized organization or agency under the law (only in the case of a CB