securities sold is less than the minimum amount specified by the issuer, the reasons for the cancellation of the offer for sale, and the securities subscription, etc.) - State the warning statement for

service providers relating to derivatives as specified in the notification of the SEC. “derivatives broker” means any person who, in the ordinary course of business, engages or holds himself out to the

sources and has a lower impact on the environment than fossil energy; (6/1)1 “ state ” means: (a) government administration; (b) government organization under the Law on Establishment of Government

specify) Full name as per Passport Date of birth (DD/MM/YYYY) Passport number Identification number Country of issue of Passport CPA license number Issued by Country Home address City State Postcode Country

_______ 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

Thailand; (3) an international financial institution; (4) a juristic person established under a specific law; (5) a government agency and a State enterprise under the law on budgetary procedure; (6) the

(company) (* The registration statement shall be signed either by a CIS Operator or an authorised person of the CIS Operator. The person who signs shall state his/her full name and capacity and shall ensure

) _________________________________________ (company) (* The registration statement shall be signed either by a CIS Operator or an authorised person of the CIS Operator. The person who signs shall state his/her full name and capacity and

signs shall state his/her full name and capacity and shall ensure the declaration is dated.) Form updated as of June 2021 Name of foreign collective investment scheme (CIS): Home jurisdiction: Name of

. “derivatives broker” means any person who, in the ordinary course of business, engages or holds himself out to the general public as being ready to engage as an agent in the business of trading in derivatives