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

/ 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

organization; (2) provincial administration organization, municipality, Bangkok Metropolitan Administration, Pattaya City and any other local government organizations specified by law as special local government

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

UNOFFICIAL TRANSLATION 2 Office of the Securities and Exchange Commission 333/3 Viphavadi-Rangsit Road, Chomphon Subdistrict Chatuchak District, Bangkok 10900 www.sec.co.th Tel: 0-2033-9999 Fax: 0