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FORM FOR ALIEN TO NOTIFY OF STAYING LONGER THAN 90 DAYS

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DATE MONTH YEAR
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TO: THE IMMIGRATION OFFICER
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(FULL NAME IN BLOCK LETTERS)

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NATIONALITY VISA o NON-IMM .

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ENTERED THAILAND ON MONTH YEAR BY
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PASSPORT NO. ARRIVAL CARD NO.
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I HAVE NOW BEEN STAYING IN THAILAND FOR 90 DAYS AND MY PRESENT ADDRESS IS

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LANE/ROAD TAMBOL AMPHUR

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PROVINCE PHONE
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SIGNATURE
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NOTICE:
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ALIEN MUST NOTIFY THE IMMIGRATION OFFICE EVERY 90 DAYS

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FOR OFFICIAL USE ONLY
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HA YE RECEIVED NOTIFICATION OF STAYING IN THAILAND FOR 90 DAYS FROM

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NATIONALITY ON DATE MONTH YEAR

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HOUR
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SIGNATURE IMMIGRATION OFFICER