: ......................... Sub-district: ................. District: ...................... Province: .................. Telephone: ................................................... Facsimile
gather information on name, last name, nationality, occupation, residential address, contacting address, name of ultimate beneficial owner, name of ultimate controlling person, name of the entity
/ Soi Road Sub-district District Province Zip Code Country Tel. Fax. E-mail Overseas Address : (only for a non-Thai national, please specify overseas contact address) 1.6 Academic Background Highest
appeared in the census registration: Address No. …….………... Moo No. ………….... Trok/Soi ………......…. Road …………….... Tambol/Subdistrict …………... Amphur/District ……. Province …………… Postal code ……..…….. Telephone
of spouse ……………………………………………………... Former name (of spouse) ………..…………………………………... Occupation …………………… working place ….…..… 2.7 Number of children …..persons (if any) (in case of change of children’s
UNOFFICIAL TRANSLATION 2 Office of the Securities and Exchange Commission 333/3 Viphavadi-Rangsit Road, Chomphon Subdistrict Chatuchak District, Bangkok 10900 www.sec.co.th Tel: 0-2033-9999 Fax: 0
member of a district council or district administration, or a member or official of any political party; (4) not being a civil servant having a permanent position or salary, or an officer or employee of