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

_______ 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

: ............................................(authorized person) for and on behalf of ................................... Contact person: .................................................... Phone: ......................... E-mail

persons. Companies should arrange a call tree and a name list of customers, the main service providers and other relevant persons, including contact information, such as an office phone number, home phone

........ Year ............. Year ............. Year ............ Total assets Total liabilities Shareholders’ equity Total income Cost Net profits Earnings per share (EPS) Debt/equity ratio (D/E ratio) Return on

clearly determined and tangible e.g. fund performance, management company’s performance, market share, etc. The long-term plan should demonstrate the direction of the business and the future plan such as

........................... Contact person: .................................................... Phone: ........................ E-mail:............................ Remarks : 1. In case of domestic branch office, the applicant is

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

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

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