"" t.

I "i~fltl1J't1"HtTtlAhJ~m"itl't;fty'ft
"iUUUatltJA ..,4 11

I ..,QJq 0 IV
flUJlIU1"i' QIsD n't1~"'''i~''i'''1Jtyqrftm''i''H''U''tl~fI'UftHAll 'n.fl. isnCi:Ci:Q

The Information for Work Permit Issuance

According to Section 12 ofthe Working of Aliens Act, B.E. 2551

1. 11o\jl:lflUt;hnhJ (Alien Infonnation)

1.1 ~O (fIll:n 'l1V) U1V/'Ul~/'Ul~iYl1 ......................••.......• ... 'UllJ iYfla ............................. .

Name (Thai) Surname
~I ~. ~
iYty"lflt;! ....................OlQ.............. :u 11..1 !~OU u !f)~ ........ .1........ ./ ........ ln.d l:I'Ht;! ....... ..

Q.I Q Q.I 4 '1 ""

Nationality Age Years Date of Birth Blood Group
~O (flUner~flql:J) Mr.lMrs.lMiss...................................Surname.............................. ..
Name (English)
,J "
1.2 l10~ '1..1
tl 'I~tl1fti
l1[1,!l:I'tll1.............'H\j/"l,flJ'lfU
J I
..........................81fl1'I .............................
Address in Thailand No. MooNillage Building
C)fOV............................... t1u'U .............................. U'tl1~/ifil':lJa ................................ .
Soi Road Sub-district
o QI Q,I

t'tlt;!/OltflO ............................... 'i)~'H1~ ..............................'I'HiY u'Il:JWV ................. ..

Q,I i. 1 .. ~

District Province Post Code

.., l1~......................................
1l1'Ift.... 1lI.1 .. ~"" d "" ~
~ u 'Il:JWVO!l:Ifll1'I 01..1 fliY ............. , ........................ .

Telephone e-mail

1.3 0 'Ht1~ffm~'Ul11~/!OfliYl'IHl1'U'Ht1~ffm~Ul11~ 0 '':IJ'fhfltytl'I~~119l1f1'U~1~¥i'11 0 'mhfltygu~od

Passport/Other Traveling Document ID card Residential Document
ta'tl~ .................................................... 00fl''Il'~ ............................................... ..

Number Issued at
QI
OOmUl1 (1'1..1
d Q,I a '!II
t~O'U u) ...... .I ......... .I.........
1'If~~~t1n'Ul1(1'U
iJ~ d Q,I .a ~I
Q.I
t~O'U u) ......... .I ......... .I....... ..

Date ofIssue (DIMN) Valid until (DIMN)

.1
1.4 t;!'I1'ila~t;!'Ilu'I~tfll1
. ..
.
~-
....................... Jl:I'tll1 ............................OOfl \'Hl1 ...................... ..
Type of Visa Visa Number Issued at
Q,I d Q.I a "='1 .d ~ ~. til '" iJ4 Q,I Q,I

00fl1'Ul1 (1'1..1 t~O'U u)...... .I......... .I......... ~'If ~fN1Ul1(1'U t~OU u) ......... .I......... .I........ .
Date of Issue (DIMN) Valid until (DIMN)
A 4' ftl lI'I
.,
QJ I Q,I 4
. ~
1.5 t~'Ul11~lJltl~u'I~!l1ft ~l1[1f1Htm.'{~ 1'Ul1 ............. t~O'U ...............................ft ....................

Date of Last Arrival in Thailand (DIMN)

i¥i'i'':IJO'4tylt;! ''Il'od''U'Il''lf81W111mO~ 1U~ .......... .. .t~OU .........................'".ft ................ ..

Pennitted to stay until (DIMN)

 'P 'P _I
2. 'UtJlJft'UlrJlll~/ffm'UlJ'!i:::m)'Utll'!i (Employer/CompanylInformation)
'"
.
cO 'P
2.1 tft'U'VJ'VJ:::t'UrJ'U fll'!ifll .. " .......•.................................................................................
Business Registration Number

2.2 4tJffOl'U'!J'!i:::ntJ'Ufll'!i .......................................................................................... .

. .,
Name of Company
.QCV 0' QI G) I t:S
. ,
'VJ~lHn'Uml'U tlfty tft'U'VJ .............lflJ1"I!lJ'lflL ........................tJlf11'!i .............................
Head Office Address No. MooNillage Building
'1ftJrJ ............................... O'U'U ............................. Jl'U1~/~1'UtI ................................ .
Soi Road Sub-district
o QI QI QI lfJ .... dot!
~'U~/tJ1UltJ ............................... 1l~lf1" .............................. '!ilfff !lJ'!illWrJ ................. ..

District Province PostCode

1'VJ'!ifl'Yfn............................................. 1'VJ'!iffl'!i .................................................... .

Telephone Fax

. .,
.qQ,l~QI 4
. ,
2.3 'VJ~~l.ll'Ufl~l'Uffl'Ul &ft'U'VJ .............lfl,d/"l!lJ'lf'U ..........................tJ1f1U ..............................
Branch Office Address No. MooNillage Building
'1ftJrJ ...............................o'U'U ............................. Jt'U1~/~1'UtI ................................ .
Soi Road Sub-district
o
!'U~/tJ1UltJ ............................... 1l~lf1" ..............................'!ilfff
QI QI QI i-lJ'!illWrJ
1 '" "
................. ..

District Province Post Code

1'VJ'!ifl'Yt'tl.............................................1'VJ'!iffl'!i .................................................... .

Telephone Fax

(,,fu'UmijflffUt~lJ1'Umw ~ UlftllrJffl'UllJ 1'Yt~tJlJ~1rJ 1"rJU-«ijlJtlfI'!i'U~llJ-«ij 2.2)

(In case there is more than one branch, please write down addresses of all the branches in

the additional paper)

.
_I '"
2.4 lJ'!i:::tfl'VJfllltll'!i ('!i:::'t,!1lf~Hfl'U'VJ'il"'VJ:::t'lJtI'U)
'P .... '" '"
..................................................................
Type of Business (as specified in the business registration)

3. -«ijlJfttll'!iij~tyl~fh~l'U (Permission to Work Information)

3.1 '!J'!i:::1fI'VJ~1'U~'~i'm)~tyl~ .................................................................................... .
Permitted category of work
llflllW:::~l'U ...................................................................................................... ..
Nature of work
0' 1
.
iI,4 .c:S of!:), .c:S
~ lU If'U~lf'U l'VJ/tJl'lf'Yt//1'lfl'lf'Yt ............................................................... , ................ .

TitleiOccupation/Profession
 &ifl'W''Il ............................................................................................................... .

Conditions
o
...
OJ IOJ c:I ~ OJ d
.
'i~fJ~n,;, lfl'41Y l~/ 'IlfJlfJ'i~fJ~n';'11'l1~ 1'W~ ~U~1'W1'I ........ , .................tH1'W 1'1 ••.••.•••...•••.•.•.•••.•

Valid from (DIMN) Until (DIMN)

, 'JI ... ...
flfln 'tY w "~'tY1'1. ................................................................................................. .

Issued at (Province)

mJ1fJm~ : hh"I1'U'l.Jlt)fltYl1,h::flt)'l.J~~if
n1wii'U'IID11JD"I'II19JYiHl'U
(1) l1u~nt)~'~l1tYfl~11'~i''l.Jt)tjf.1Pfl t '!f1"htJ nh~l'U9JltJfltll1tJ1fJg'U

- l1U~ntl'Olflnluml'Ufltu::flnlJfll1ri~ltY;tJfll1lHl.J'U (B.O.t)

- 11lr~ntl'Olflfll1UfltJtl9JtYll1m1tJuMnh ::!JlfT'lflU (IEAT)

(2) rill'Ull1u~nt)i'mt)~u~hJflfln ('l1Jlfl'U 61tltl'U)

(3) 11hhfJl1.y'19J1~ 'II'Ulfl 3 x 4 "lflJ. (li1u'lliln'U 6 ltltl'U) ~1'U1'U 3 111 U~~fllfJt1mVt
(4) nll'UlltlfltY119JltJ'Ii'tl 1.3

n1w~'U'IID'IIUlu1::u::mnl1JD"I'II19JYiHl'U tMl~lt)fltY11 'li'tl (1) (2) um: (4)

Remark: The following document must be attached when apply for

Work permit
(l) The letter approving the applicant to work according to other laws

- Letter from B.O.!.

- Letter from lEAT

(2) A copy of the Company's Affidavit (Certificate of incorporation) issued by Department of

Business Development not longer than 6 months)
(3) Three (3) recent photos, 3 x 4 cms., taken not more than 6 months with proper attire.
(4) A copy of identification document specified in 1.3 above (Passport! ID card! Residential Document)

Extension of work permit - same as above except No.3 is not required