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

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

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

office, type of business, company license number, telephone number, facsimile number, home page (if any), amount and type of the total sold shares of the Company; (2) Name, head office, type of business

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

) ………………………………………………………… 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

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