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

appeared in the census registration: Address No. …….………... Moo No. ………….... Trok/Soi ………......…. Road …………….... Tambol/Subdistrict …………... Amphur/District ……. Province …………… Postal code ……..…….. Telephone

/ 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

_______ 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

in the house register: Address No. …………... Moo No. ………... Trok/Soi ………...…… Street ………….... Tambol/Khwaeng ……….. Ampoe/Khet…… Province ………… Postcode ……….. Telephone number …………...... Name of