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

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

…………................................................................. …………………………….......................................................................... 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

, 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

: ___________________________________________________________ Tel No.: _____________________________ Fax No.: _________________________ 15) Is the CIS Operator currently licensed or authorised to conduct fund management in the economy of its principal place of

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

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

: Name/Position (at least CEO or equivalent): ____________________________________ Email address: ___________________________________________________________ Tel No.: _____________________________ Fax No

: Name/Position (at least CEO or equivalent): ___________________________________ Email address: ___________________________________________________________ Tel No.: _____________________________ Fax No

....................................................................................................................... telephone:................., facsimile: ..................., Website /home page: ………………..................., e-mail: address..........................., branch office located at (if any