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
Experiment and Develop Innovation in Support of Service Provision Related to Capital Market Which Are Not Deemed an Undertaking of Securities Business For Which an Approval Is Required _____________________ By
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
Experiment and Develop Innovation in Support of Service Provision Related to Capital Market Which Are Not Deemed an Undertaking of Derivatives Business For Which an Approval Is Required _____________________
securities company; or (b) an appointment is made in accordance with Section 145; (c) the securities company is a state enterprise under the law relating to budget procedures. (8) being a manager or a person
government agency and state enterprise under the law on budgetary procedure; (8) the Financial Institutions Development Fund; (9) a juristic person having total assets of five hundred million baht or more