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

Date : (Please attach a copy of identification card or passport) 1.3 Nationality : 1.4 Date of Birth : [ specify director or executive’s full name ] 1.5 Current Address : # Village / Building Moo Trok

in the house register: Address No. …………... Moo No. ………... Trok/Soi ………...…… Street ………….... Tambol/Khwaeng ……….. Ampoe/Khet…… Province ………… Postcode ……….. Telephone number …………...... Name of