_______ 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

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

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

risk management. 4. There should be an establishment of a compliance unit to supervise and monitor the operation that is independent from the management and other units. 5. Operation conducted with

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

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

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

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

for approval: 1.1 The position applied for approval: O Director: O having power O having no power O independent director O Manager: 1.2 Relationship with the shareholder or group of shareholder, such as

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