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

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

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

_______ 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

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

: ......................... Sub-district: ................. District: ...................... Province: .................. Telephone: ................................................... Facsimile

) ………………………………………………………… Location of head office ……………………………………………………………… …………………………………………………………………..…………………… Telephone number …………………….. Facsimile number ……………………….. Part 2: Category of an applicant □ A commercial bank under the

…………................................................................. …………………………….......................................................................... telephone number…………………….. facsimile number ………………………… 2. Details for supplementing the consideration: 2.1 A license granted by the authorized organization or agency under the law (only in the case of a CB

or order must be kept until the complaint has been completely dealt with; If the giving of advice or placing of order under the first paragraph has been made via telephone or by electronics mean, a

such complaint is completed; In cases where the giving of advice or placing of orders under Paragraph 1 has been made via telephone or by electronic mean, a record of audio tape or electronic recording