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

uncertainty concerning entity’s ability to continue as a going concern (paragraph........); ( 5.2 An uncertainty relating to the future outcome of exceptional litigation or regulatory action (paragraph

apply) ( 5.1 Using of going concern assumption appropriate but a material uncertainty exists (paragraph number.......) ( 5.2 An uncertainty relating to the future outcome of exceptional litigation or

_______ 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

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

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