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
institutions holding securities business licenses, which are under direct supervision of other regulators and are subject to anti-money laundering and terrorist financing regulatory and oversight regimes that
internal audit and regulated by other competent regulators according to the notification of the SEC. The SEC Office has the power to waive the appointment of independent director temporary or permanently
such services; (12) clients’ asset An intermediary shall arrange adequate protection for clients’ assets when it is responsible for them; (13) relations with regulators An intermediary shall deal with
license and evidence on renewal of such license; (11) Copy of Identification Card; (12) Copy of the Shareholders Name List (Form Bor. Or. Jor. 5). In this regard, I confirm my willingness to provide
indicating such change) 1.2 Type of Card [ ] Identification Card [ ] Passport (only for non-Thai national who does not have an identification card or does not know identification number) Card Number : Expiry
regulators under such laws shall have the power to issue ministerial regulations governing consideration or computation of the trust property as the property of beneficiaries for the purpose of complying with
already had independent director in accordance with the regulations of such regulators, it shall be deemed that the intermediary has had the independent director in accordance with this Notification. In
which can be issued or offered for sale in Thailand, unless otherwise prescribed by the SEC Office; (2) being an outbound product under the supervision of any of the following regulators and the trading
): ......................................................... ………………………………................................................................................................... 2. Identification Number: ............................................................................................................ CPA License Number