ສາ຋າລະຌະລ ັຈ ຎະຆາ຋ິຎະໄຉ ຎະຆາຆ ົຌລາວ

LAO PEOPLE’S DEMOCRATIC REPUBLIC

ສ ັຌຉິພາຍ ເຬກະລາຈ ຎະຆາ຋ິຎະໄຉ ເຬກະພາຍ ວ ັຈ຋ະຌະຊາວຬຌ
Peace Independence Democracy Unity Prosperity

ວ ັຌ຋ີ/date: ____/____/_____

໇ ຄກາຌຆ-໇ ຂາງອຌ
ໃຍ຃ ໍາອຬ ໇ ຋າຄຬິຌເຉິເຌັຈ
Home Trading System Application

ູ ຋ົໆ ວໄຎ / General information:

໇ ຌ
ຂໍມ
ຆໆ / Name: ______________________________ຌາມສະກຌ/ Surname: __________________________________
ເພຈ/Sex: ___________ ວ ັຌເຈຬຌຎີ ເກີຈ/ Date of Birth: _______________ ສ ັຌຆາຈ/ Nationality:______________
຋ີໆ ຢູໆຎະ຅ຍ ັຌ/ Address: ________________________________________________________________________
ໂ຋ລະສ ັຍ/ Telephone: _______________ໂ຋ລະສ ັຍມຊ/ Mobile:______________ໂ຋ລະສາຌ/ Fax:____________
ຬີແມລ/໌ Email address:_____________________________________ (ຌ ໍາໃຆເ໇ ພໆ ຬ ຄຢຌກາຌຆ-໇ ຂາງ຋ີໆ ມີກາຌ຅ ັຍ຃ູ)ໆ /
(Needed for sending your confirmation number)
ເຬກະສາຌ຃ ັຈຉິຈ /Attached documents:
ຍ ັຈຎະ຅າຉ
ໍ ົວ ໜັຄສຏາຌແຈຌ ຬໆ ຌ໅
 Id card  Passport  Others

ເລກ຋ີ / No: ________________ ຬຬກໃຫວ ໇ ີ/ Issued at _______________

໇ ັຌ຋ີ/ Issue date: ____________ ຬຬກໃຫ຋
ໍ ົຈ/Expiry date: ______________
ວ ັຌ຋ີ ຈກາຌ

ຂາ໇ ພະເ຅ົ໇າຢັຄຢ
໇ ຌວາໆ ຂໍມ
໇ ຌ
ູ ຋ີໆ ໄຈສ ໇ າ໇ ຄເ຋ິຄຌີ໇ ແມຌ຃
໇ ະໜຬຄໃຫຂ ໆ ົຍຊວ
໇ ຌ ແລະ ຊກຉຬ ໍ໇ ຌ
໇ ຄ. ໃຌກໍລະຌີຂມ ູ ມີກາຌຎໆຽຌແຎຄຂາ໇ ພະ ເ຅ົາ໇ ເຫັ ຌ
ຈີວາໆ ຅ະແ຅ຄໃຫ
໇ ຍ໇ ໍລິສ ັຈອ ັຍອູຢ
໇ າໆ ຄເຎັຌລາງລ ັກຬ ັກສຬຌ. I certify that the given information above is complete and correct. If there is
any change I agree to immediately inform the company by written letter .

ະ - ( ) / HTS ID (For customer)

(6-8 ຬ ັກສຬຌ ຫ ຉ ົວເລກ / digits ): ___ ___ ___ ___ ___ ___ ___ ___
 ະ ໃຆ ໇ / Letter or number are allowed
 ໇ າງອຌ
ລະຫ ັຈກາຌຆຂ ໍ໇ ັຌ
໇ ຋າຄຬິຌເຉີເຌັຈ຋ີໆ ຆາກ ະ ະ . ະ ະ ຋ ັຌ຋ີ ລະຫ ັຈ ໄຈຊ
໇ ກຌ ໍາໃຆ ໇
Exactly Same name or number for all 6-8 digits is not allowed to register. System would automatic popup reply that this
user is already exist.
 ະ “LX” “lx” / First two digits could not register exactly
“LX” or “lx” letter.
 ເ຃ໆ ຬຄໝາງສະເພາະຈຄໆ ັ ລມ ໇ ມຌຍໍໆ
ໆ ຌີແ ໆ ຬະຌງາຈໃຫຌ
໇ ໍາໃຆໃ໇ ຌລະຫ ັຈ 6-8 ຉ ົວ: ຉ ົວຢາໆ ຄ : ] [ ? / < ~ # ` ! @ $ % ^ & * ( ) + = } | :
" ; ' , > { ແລະ ງະຫວາໆ ຄ / All 6-8 digits could not apply special character including space bar : Example: ] [ ? / < ~ # ` !
@ $ % ^ & * ( ) + = } | : " ; ' , > { space

ຍໍລສ
ິ ັຈ ຫ ັກຆ ັຍລາ໇ ຌຆາ໇ ຄ ະ ລາງເຆັ ຌຏູອ
໇ ຬ
໇ ຄຂໍ
Lanexang Securities Public Company Applicant Signature

1 ສາຏັກງາຏໃຫ່ຊຌັັ້ງຢ່ຉຏ
ັັ້ 5 ຬາຄາຏຌະຫຼາ຋ຫຼກ
ັ ຉັຐລາວ ຐ້າຏໂພຏຎັຏ຾ໜືຬ ຾ມືຬງໄຉ຾ສ຋ຍາ ຏະຄຬຏຫຼວງວຽງຈັຏ Tel: (+85621) 265461-4
LXS 5 Floor 5TH of LSX Building Ban Phonthan Neua, Saysettha District Vientiane Cap., Lao PDR Fax: (+85621) 265465-6