· created date: 8/18/2011 1:37:59 pm
TRANSCRIPT
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duranglrnrufi:u rnnurtaR-t stu 7 fuv|.tn-tt\n/wvv.doe.go.th lvr:. A 2245 2745, A 2354 0115
W.P.1(FOR FIRST TIME APPLICATION OR REAPPLICATION DUE TO EXPIRING)
QUALIFICATIONS OF AN APPLICATION1, Having residence in the Kingdom or having permission to stay in the Kingdom temporarity under lmmigration law
(onty NON-IMM|GRANT VISA is acceptabte).2. Having the knowledge and/or skilts to perform the work as stated in the apptication for a work permit.3. Not being insane or merrtatty sick, suffering from Leprosy, Tuberculosis, Drug Addiction, Atcohotism, Etephantitus and
Tertiary Syphiiis.4. Never having been imprisoned for violation of the lmmigration Law or the Working of Atien Act at least one year prior
to the date of apptication.THE MAIN DOCUMENTS REQUIRED Ptease arrange documents in the fottowing order:1. AppLication Form with 3 (3 x 4 cm.) recent photographs (taken within the tast six months, not printed by
computer/Potaroid)2. FORM OF THE EMPLOYMENT CERTIFICATION3. Passport and one copy of atl. pages or Certificate of Permanent Residence and Certificate of Atien with a copy.4. Copy of the appticant's education certificate and job experience record. (Form deslgned by Department of
Emptoyment is accepted in case such foreigner cannot submit the copy when apptying)5. A copy of occupation or profession license, in case which is prescribed by the retated [aw.6. Medicat certificate showing that the appticant does not suffer from prohibited diseases, as identified by an
item 3 of the above quatifications. (lssued within the last six months).7. Map showing the location of company/enterprise8. Power of Attorney with 10 Baht duty stamp affixed and a copy of appointee's l.D. card (if the appticant is
unabte to appl.y in person).9. A Power of Attorney made by the empl.oyer with 10 Baht duty stamp affixed and copies of emptoyer's and
appointee's l.D. card.Supported Documents as category of emptoyer1. Company1.1 A copy of Thai Company Registration and a copy of recent shareho[ders' List. (Updated within six months). Or
foreign juristic person needs to submit a copy of Business Operation License of such foreigner and document aboutmoney import.
1.2 Copy of VAT Registration; form Phor Por 01 identifying type of business and Form Phor Por 09 if there is any change.i..3 In case of foreign emptoyer, a copy of emptoyer's work permit is needed. lf the empLoyer is not working in
Thail.and nor has no work permit, Power of Attorney certified by Notary Pubtic and Thai Embassy is needed.1.4 Company engaging any business which a [icense from the retevant Authority is needed, for exampte: Factory
License, Restaurant License, Liquor License, Cigarette License, Hotel License, Tourism License, Hospital License,Chemicat lmport License, etc.
1.5 A copy of Sociat Security Payment. And a copy of updated income such as Batance Sheet and VAT Payment; Phor Por 302. Private schoot teacher I Priy..qte..Uilv.ersj.ty.2.I A copy of letter of teacher or instructor assignment and empLoyment contract / PriU-q{te-u.niVAr5fy.hq$.la."5hqW.thg,
cerln cc:te..lelter frnm.the.qrs s n Eati a n.af . Min i sW. pf. Educqti p n,2.2 A copy of teacher ticense (as Law of The Council of Teacher and Educational Person), except for trainer.2.3 A copy of the license of the school establishment, manager license, headmaster license / g.Cqpy.Of..the-ltcen1e.Af
the.unwersiM.estshlishment.and.a.eppy.qf.the.dpc.umentp.show.Ihe.namz.ef.qw.Layar.ha,s.the.rightf.qrsgntrg.snt h e. hehq'f ,.of ,.the..wtj y.ers iW,
2.4 Copy of educational certificate and teaching experience record (if any).3. Government organization / Teacher of government school3.1 A certificate tetter from the government organization,/ Ministry of Education and schoot, which shows appiicants'
name, position and work period.3.2 In case of teacher of government school, a copy of teacher license (as Law of The Council of Teacher and
Education Personat) is need. The trainer is not included.4. Association/ organ ization/ foundatio n
License of association/ organization/ foundation establishment (ptus the list of managing director)5. Fil,m making5.1 A tetter from Ministry of Tourism and Sport show the list of applicants' name, position and passport number and
coordinator license.5.2 A copy of Company Registration and a copy of recent sharehotders' list (updated within six months).
Remark(1) Any documents in foreign language other than Engtish must be transtated into Thai and certified by an academic
Thai native speaker. Atl the Forms have to be fitted in Thai.(2) Every page of the documents betongs to the company need to be certified by the authorized person or the
appointee with company seat. Every page of the documents betongs to appticant need to be certified by theappticant himself or the appointee.
After fte applicdion is completell, t6r pooess will be finished wihin 7 worfting days.www.doe,eo.th Te[: 0 2245 2745, A 2354 0115
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W.P.l (ln case of a teacher/ instructor)(FOR FIRST TIME APPLICATION OR REAPPLICATION DUE TO EXPIRING)
QUALIFICATIONS OF AN APPLICATION1. Having residence in the Kingdom or having permission to stay in the Kingdom temporarity under lmmigration taw
(onty NON{MMIGMNT VISA is acceptable).
2. Having the knowtedge and/or skitts to perform the work as stated in the application for a work permit.
3. Not being insane or mentatty sick, suffering from Leprosy, Tubercutosis, Drug Addiction, Atcohotism, Etephantitus and
Tertiary Syphitis.
4. Never having been imprisoned for viotation of the lmmigration Law or the Working of Atien Act at teast one year prior
to the date of apptication.
THE MAIN DOCUMENTS REQUIRED Ptease arrange documents in the fottowing order:
f t. npptication Form with 3 3 x 4 cm.) recent photographs (taken within the tast six months, not printed bycomputer/Potaroid)
f Z. Copy of the appticant's education certificate. And teaching experience record (if any).F a. U"dicat certificate showing that the appticant does not suffer from prohibited diseases, as identified by the taw.
(lssued within the last six months).
E C. Rassport and one copy of atl. pages or Certificate of Permanent Residence and Certificate of Atien with a copy.[ 5. Po*er of Attorney with t0 Baht duty stamp affixed and a copy of appointee's LD. card (if the appticant is unabte
to appl.y in person).
I O. n Power of Attorney made by the emptoyer with 10 Baht duty stamp affixed and copies of emp(oyer's andappointee's l.D. card.
Supported Documents as category of schoolGovernment School
m 1. FoRM oF THE EMpLoyMENT cERnFtcA]roN- To be signed by school Director, if schoot is under
Office of The Basic Education Commission (OBEC)/ OR
To be signed by schoot director or District
director, if school is under Bangkok Metropolitan
Administration. And a copy of Announcement of DirectorAppcintment or a copy of Director's lD. Card.
n 2. A certificate letLer from the originat affitiation(OBEC, District), which shows appticants' name, position
and work period.
n 3. A certificate of teaching profession from the
Teacher's Council of Thaitand fiust one item)- Teacher license- Guarantee letter- Permission letter for teaching without license
Receipt Letter which shows the ticense is underprocessing and appticant can teach without ticense.
- Paper of defining exemption of license
Remark(1) Any documents in foreign tanguage other than Engtish must be transtated into Thai and certified by an academic
Thai native speaker. Al,l. the Forms have to be fitted in Thai.(2) Schoot's documents shatt be certified by the authorized director or the appointee. Appticant's documents shatl be certified
by the appticant himsetf or the appointee.
After the appllcaton ls completely, tF pnroo$s will be finlshod uihin 7 un*ing daye.
i-
iIII
Private Schoot
n 1. FoRM oF THE EMpLoyMENT cERTtFlcATtoN
- To be signed by schoot ticensee or grantee.
tr 2. Letter of teacher or instructor assignment and
empl.oyment contract.
il 3. A certificate of teaching profession from the
Teacher's Counci[ of Thaitand fiust one item)
- Teacher ticense- Guarantee letter
- Pennission letter for teaching without LicenseReceipt Letter which shows the ticense is under
processing and appticant can teach without license.- Paper of defining exemption of license
Exemptiqn
- In case of apptying for an instructor in Non-
academic schoot, the foreigner is not necessary toobtain a certificate of teaching profession.
fl 4. The license of the school establ.ishment and various
licenses.
lAnvvlr.doe.go.th Tet: 0 2245 2745
LLUU glVl. o
FORM WP. 1 tl e d
lfl?t1v[0114U1y|
FOR OFFICIAL USE ONLY9' 4i
LntSuvl
n53Jn1:09tfi1'1'lU
DEPARTMENT OF
EMPLOYMENT
n:uvll?{$?{{'lu
MINISTRY OF LABOUR
ri'rsoiu'Luoumwitru9o. '
n18Jil',lFt:1 6(
APPLICATION FOR A WORK PERMIT
UNDER SECTION 9
e./ d-?uvt:uA ,,e'?10tJ51J
1r,
tuaunnmLaflfilcr l
6ly4
aan Luu"Jn.v e)
a{?1?91
1,uJ "l u tn til :vqi'r 6'r nud T t 6't?
1.t r r lgoilanunl{9r1?
(U
Atien's Information
1 1l l
4 9'rA o
lJOzuUUF|1?JO u'tgl/u1{/u1{a'l?U
Name of appticant Mr./Mrs/Miss
fi'nrqJrfiI
Ae)c{
tnqluvl Fl'rFr il
Nationatity
i z fiarflusi'r..rt lzvnnq
Date of birthI
Ase Years
U
rj:v nn+ :ri'atr l:r+rfiriCountry. j .c l ,u
r.3 fiodLuil:urilalilu rn?fi
Postcode,a j
uLllt/Fl'l Ft''): qIO FIU
Address in Thail .and
fluu.
No. ruJoZguitding
sfrrt raluqrrr
5oi
pir tna/tqrn
Thanon
d'rrniBr
Tambon/Khwaeng
:#ah l:r"lfipi
Amphoe/Khet
Tvr:6'rruvi
Changwat Postcode Tetephone
Tu:ar: h l:r"uflrifrrfinvr:afindFacsimite E-mait address
1.4 rona''riraprtnr:16'iuor.gryrmt#oq'[u:rrorruron:oei'rqlnodtr,rd{eKeietdiiDocument showing a permission to stay in the Kingdom as fottows:
(1)n vrirdorfiuvrrr n ronar:Wuyurau-rf,0rfiuvrx...................Passport Document in lieu of passport
La?rvr. . . . . . . . . . . . . . . . . . . aanlrXf i r t5:r lv lFr
No.6t tve,, ;
oan Lu?uvl
lssued at Country61 9*l v< s,t
j
Lqf Lafl{ ' l1lvl
Date of issue
n:?q]n{a511 J:v mvr
Val.id unti[i
LA?IVI61 9/d
6t 6t n luvr
Type of visa6l yv i
Fian Lu?ul/l
No.6I ?4 1r< e,, iL9f 1ofl,,1'lllyl
lssued at
Date of issue
tfr uu r t I r fi.: :'tuo't rur d'n :t l
dard
r lJO?Uvl
VaLid unti l
Date of arr ival at the Kingdom
toi'iuorlrgrmrrnvr#nrurd'rufirfin:ranrur{rrfio.: tu dtfin',:urtronrutci'trfio.iHaving received a permission from an immigration officer at the immigration chackpoint
!
To be abte to stay in the Kingdom untit
. .o . -d d(2) LuAln6UnUiloUCertificate of permanent residence
j qsd v v
No. lssued at Changwatqvv A qt4v4 y 4
Date of issue VaLid until.
(3) tudrd'ryrJ :v iird'rnusi'xpirrAtien identification card
d q /..
No. lssued at Changwatqvv A quva q A
Date of issue Vatid until.
Highest educational qual.ification obtained Fietd Year of attainmentJ-
Name of institute Country
Having attended training on Period of training course Month(s)A'"ea(s)
Work experience
"" t"""""""""
: : : : : : : :
. , . : : : : : :
: : : : :
- _ y 1 a a O @!(1.5 n{ 1. / nliltv{lltnr]L14t?,[0nfi1:$uu)
Forfurther information of any item in 1.5 to 1.7, pLease attach documents.
2. {oryan1T?f oox{ry1FlApptication f nformation
Category of work being apptied
a"nuruvnu
Nature of work in detait
. . . :
Titte,/ Occupation,/ Professionziu
Name of empioyer. j , . i
Address No. Moo/Buitding Soi
Thanon Tambon/Khwaeng Amphoe/Khet
Changwat Postcode Tetephone Facsimite
23 aanfvirnutornusir
Ptace of work No. N,lio/euitding Soi
Thanon Tambon/Khwaeng Amphoe/Khet
Changwat Postcode Tel.ephone Facsimite, do e(:vqaorufrdtru sirfi:rnn'jrrafirirvir)(ln the case where there are more than one ptace of work, ptease speci! aLl)
Had been granted a work permit No. lssued at (Changwat)
3. rondl:$au?lang'luDocurnents and Evidences
y o 4 v v\aA s u r q,&il:0iln190u tlvr[01 lngu[0nd1:uavuafl61ua{n0luuTogether with this apptication, I have attached herewith the fol.l.owing documents and evidences:
3.r tr eirruurftf,orduvnr raioCopy ofpassport, or
n drrurronar:l{uvruvrirf,ordumrr uioCopy of document in lieu of passport, or
tr rirruT'lurirdryilrsdrfr'rnurirc6'rruavrirrurlu;ird'rpfi udoqCopies of Atien identification card and Certificate of permanent residence.
3.2 tr eirrulndngrunrrorirgrnlrird, rLrlu:rrorrur{n:Copy of evidence of permission to enter into the Kingdom.
3.3 tr dturronar:iu:or'1finr:finr*r u6oCopy of certificate of education, or
n vrirdoir:orrorq'firrnrurfluuru6'x:v11:runvuduorrfiurniudnuruvro{d'rurau:vuut?a1n1rvrel{'rudy. i u afl ryuiln1to[Fluvrl{1ua?u y:aRecommendation of a previous emptoyer describing nature of work and working period of an appticant who was emptoyed,or
tr vru-rf,oYu:ortorfi6crvr{luuru6"rcuaqvirri6ur{rtol{Jurifinrrufuavil:vaunrrnirurrsarfi'urtufiroir'lr.roqrgrm
$ ! s
Recommendation of a prospective employer describing that an appticant has proper knowtedge and experience
for engaging the work.
3.4 tr a{rrurhorliyrnil:vnouitndutun:cflfir{Jun1:!:snouitrf,vrfin4rnururil,runlrX6'ort6'iuluo1ryrmr.l:vnouiufiilCopy of license for professional practice in case that it is required by taw to have such license for engaging the work.
3.5 tr r,rfiidoir:ornrr6'rrtorfrfirovr{Juuru,irrTnu:vqruqnadhi6'rqn o,a#rgtrfilvrudrvrue&t-, ' i
y'{l0lJy{fi an51uu5V n oLtl4st r{n n{nn1?
Work recommendation of a prospective emp(oyer describing reasons for not employng a person of Thai nationatity to wor( together
with support ing evidences.
3.6 n:niursdrrr{luqnnas::uorIn case the emptoyer is a Natural Person
D eiruutim:il:vdr6'r!:vrruu$avdrru'rvrvrfiuurirurorqi,dmvr{Juure6'rr u6oCopies of ldentification card and house registration of a prospective emptoyer, or
tr iiriuryri.rf,orduvnltorfifirovrfluutu6'rl r,riaCopy of Passport of a proryective emp(oyer, or
n eir ru'rluaird'rgiiudoqjror{drqvr{Juulu6'1.iCopy of Certificate of permanent residence of a prospective emptoyer.
n:dursd1.rrflufifiqnnaIn case the emptoyer is a Juristic Person
tr drturtonar:Yu:orcJoreiru:'wn1:firfiu?rioruaox'irfirn1:ra{rifi{aurtjuuru{'rrt6'anflstfiuuvr5oldiuourursrl#o-ard.runvrfrrfiurruTnunn6'0{a'rilnnrarrer lriuuarwil:vmilfiqnr:d'rerCopy ot C.rtilJut. of a relevant Government aglncy stating tf,e brsiness of a prospective emptoyer has tqal.l.y been
registered or granted a license to estabtish and operate, and the type of business has been specified.
4 Y d Ao A a d I s
nsfuultJol{il4il41 [u'114:CIfiuvt0 guof't51t o1ru1a n:In case the employer has permanent residence outside the Kingdom
tr eirrur#ryrgr6'r{rilrr1 14ioCopy of servic,e and/or operation contract, or
! ;irrur#rgcgTfiorluv6oCopy of sate contract, or
tr eirrurronar:6udsran.r'irriEiun'rtofinr,lu,ttijudornhrtirnulu:'rro'ril1dnT(:vq).............. . . ...-.Copy of other documents showing that an appl.icant has a necessity to work in the Kingdom.
(speci!)
n:rfitrifiurs{rqIn case of without an emptoyer
tr drtutonar:fiuan.r'jr4jdurirtorf,u{fin?1ilf;ravil:u6unltnirutlrsflrrrTu{'rufiroiuluarqryrn(:vq). . . . . . . ' ' ' . . . . . . . - . .Copy of document showing that an appticant has a proper knowtedge and experience for engaging the work.
(specify)
tr rirrurd'rpcyr{tuuur u6oCopy of servic,e and/or operation contract, or
tr drrur#rgryrfiorl.rrr y6oCopy of sate contract, or
tr ciriurion6r:duiiriaen'jr{Eiuriruofinrun"rr{ludo'rnir:ndrnulu:r?Jo1ru1a-n5(:vq)..............Copy of other documents showing that an appticant has a necessity to work in the Kingdom.
(sPeci[z)
tr drturluoucy'rn!ivnouf,ifionrungurru'jr6'runr:il:enoug:n0rornrusirr6'rrtun:fifir{lucrufi o qjnr utfr'r.Tr6'u nXrau ru'j'r 6'r a nrrU:snouq:n{ro{nusirtdrrCopy of Business operating [icense under the law on atien business in case that the work appl.ied for is under such [aw.
3.7 n 1rliu:ortor{rJ:vnouirrfinr?fln::ileI1iln0uil'ru'j1d?uitrfivrnrn::u fiiu:avjr{6ur{rtohiriJuqnnainarBmu6ofiisrfiurflauhiaur.J:cnouuastilr{,uI:nsrrlrfiriT vurr"lflunfln:uvri?{firoonnrrt
3.8 [
Fl?'llJLUlJ1Fl51 oo
Certificate from medicat practitioner under the law on medicat treatment professionat stating that an appticant
is not a person of unsound mind or suffering from mental infirmity, and is free from any defects as prescribed
in Ministerial Regul.ation issued under section 10.
:ilciru riuror en x d {u. dturu en :rJ3Photos(size3x4cm)
t t9)a)tg) lv
t r vr ri r r o fu : o vi r do n ? -l xJ {r q Fiu fi u{J u nr ri u qi { il n rJ : v n 1 :I hereby certify that the inforn'tation given above is true in every respect.
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SienatureI
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?uvlDate
AppIicant
lfl?rr1sr{tnrirfiFOR OFFICIAL USE ONLY
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ruuu u f.r il o iu :o r n r :{'r tFORM OF EMPLOYMENT CERTIFICAT1ON
t. riolaur gdr{ EMpLoyER's TNFoRMATToNU_
r ' r -Ef fqnnatvruorrvrvr fUudo' .uatd. . . . . . . . . ' . . . .y tuomvlfuuTHAI JURISTIC PERSON REGISTERED ON NO. PAID-UP CAPITAL
f-l aa I u a .i o a d o e
|Jijfunnagi1{'|,1?anwt[Uitijo..........................,irulutiufurrc]ri1a1nsi1{d:vtf...........'......FORIEN JURISTIC PERSON REGISTERED ON THE AMOUNT OF MONEY IMPORTAT]ON
E qnnao::ia"r ryn:d:vt'rsuhrf ........NATURAL PERSON ID.CARD NO. WORK PERMIT NO.
1.2 aaruspirunlTfiu lu:ouilfiniT uil'r rHE FTNANcTAL srArus oF rHE LAsr vEAR
:ruki flaqriu ............rt'rvr lutix:sucr']a1................................ r6ouTHE RECENTLY INCOME BAHT THE DURATION MONTHt-llJ ilan1nl:a{oon rHE VALUE oF EXPORT........... ..............U',tyt BAHTl - raro e I i e qd,
LJ !9tU1nUn',t{U:utUr,lt?'tu'tvto.llylu?lu50uuYt9.l'tulJ1............................nuTHE AMOUNT OF TRAVELLER IMPORT FOR THE LAST YEAR PERSON
l - ld v q
lJ 3JV{Ufl{lUnUtylg THE AMOUNT OFTHAI WORKERS........................nU PERSONl - la I v o e I e e o d
THE AMOUNT OF WORK PERMff HOLDERS WORK PERMIT NO,l foe<gla|J Q1U?U1,10{L:UU rHE AMOUNT OF ROOMS..........,...140{ ROOMS lJ n1uluufl$tlu THE AMOUNT OF sTUDENTS...............nU PERSON
z. dolanr:dr{ TNFoRMATToN oF EMpLoyMENTwv,a9rvA
dn,{
do
do I I
i " v I a 'Suudoluylyll{"ru 6t'ltJ'lnn?'lr4u{$14{ To sPEgFy pLAcE oF woRK tF MoRE THAN oNE PLACE.......
I
PERIOD OF CONTRACT YEAR MONTH DAY CONTRACT VALID UNTIL
r i rdrqa6o:,ra1diuay/t6ouav.. . . . . . . . . . ' . . ' . 'U1y|r . rarJ:vIUgdduiuav/t6ouav. ' . ' . ' . . . . . ' . . . . ' . ' . . . ' .U1WAGE OR INCOME PER DAY / MONTH BAHT OTHER BENEFIT PER DAY / MONTH BAHT
:sdunr:finurd{da.............. ..............rj:vaun1:nhi1{1u................fl ao1un1T,r E Tan E al:a! r
THE HIGHEST EDUCAT1ON JOB EXPERIENCE YEAR STATUS SINGLE MARRIED-
rh ry g
a. naqruafitridrn4nnadrgtrfilvrsnhd'r,{r'ru rHE REAsoN wHy Nor ro HIRE THAI pERsoN
nSoliild*uuud'nilud:snouruEfiad{nrirrd'rer 6'qd r er'rcr-ose HERn,vITH IHE olro,vrNrc Docrl IENrs FoR sJpporrlhc IHE ABCA/E FEAscfs
u v v e v 3a,{'lillal?Jo:u:o{?'l ton'l1u$'l{9luu[uun?13Jat{4nu:sfl11 | HEREBY CERnFv THE ABovE STATEMENT ARE TRUE tN EVERY RESPECT
uil1r,n4E {r{tarhdaiu:osd nvoiocr{Ju{fio"ruroaodoqnr{uaa, urJ:snounr: raiot6':'uloudrurqbh{1nr:uvruREMARK THE PERSON SIGN THIS FORM MUST BE THE AUTHORIZED DIRECTOR OR AUTHORIZED REPRESENTATION
tl n.fl.YEAR
aqrd
fiuvr:?IuA55ET
:1u16'INCOME
tiuan/rturJrnfiu1n1:CASH/DEPOSIT
riilz/tt'lptTuPROFIT/LOSS
4 a( l ,
t"t119U:t9yl
TAX
uuurari.r d a iu :a v1 6 nT :f, nur ua cil : g au n r :ninr nir vruEducation and job experience certification form
vdou{rvrr{r \iu / u1l / u1{fr1?................... .............{6ur{rmiu- l, Mr. / Mrs.l Miss appticantluorlrgrnrir{luenlJrJln:r 9 uavli1ilr{r uT eJ / uts / u1{Gt'l?.,......who appl.y for Work permit according tq section 9 and l, Mr. / Mrs. / Misssfruuilr....... .fioanrufim"r.:ru (uisvrzvirlr{uriru,firYorziru)..
::: itou,,uo,ro,fiili#;ili71{.?T"-::::::lusiruild{ ::::: :: :::: T 1Il1 ', ''"In the position
cir r rafu:avir ura / utt / u1{61?........ ....finzuartrihn:,:l, certify that Mr. / Mrs. / Miss
rnurdruvtdrdu,ilwo Inufildnr:fi nsruavil:caunr:ninr:r{'rvnr dcdto perform the work as stated in the application for Work permit shown betow :
1. rj:cifinr:finurEducation
'1dnr:finurqqnfltdiu.The highest education
41s1............ .............rfi0flfiel.d year
2. r.J:saunl:nidl{1uJob experience2.! sirutuilr
Name of employer2.2 sirttuilr
Position
period
UBdVf r . . . . o. . r r . . . . . . . r . . . t | ' . r r . . . . . . f . . . . . . . r . . . . . . . . . . . r . r . . . . . . r . . ' . . . . . . . ' . . . . . r . . . . . . . . . . . :VUdf t t j
Name of emptoyer
2.3 giru,uilrPosition
period
Name of emptoyer period{rr toiu:ovjr{onru{rrfrurflunrrlroirlnrJ:vnr: 6.rararufiodatiuflurad'ngruuoivrn
vAu:1nfi?'ln1::u:o.rruuuio {rr Euuodvirirrf,undtugruu{rnerurfiosior{1ilfinlru nlilil:vilranfluil1uo'lrur rrn:r 137
I hereby certifi/ that the above statements are true in every respect. Therefore appiicant and I signto be the certification. lf any information is not true. I consent to be prosecuted legatty against meaccording to Criminat Code section 137.
, jvdon{so............ ...........$uun11|a
has the quatification
Sign
Jn{{0. . . , . . o. . , r , , . . . . r . ' . r . . . . . . . . . . . r . . . . . . . . . lJ ' l uQld
Sign Emptoyer
4a{to .. . . . . . . . . . . . . . .", ,T1u'1uSign Witness
Appl.icant
Power of AttorneyjyAO
?tuff,oilaua1u'lq a'ln?uuRnrurJoo UlYl
Writien atO .ri
yl'lyl
Dateq/d
?uvlMr./Mrs./Miss.
hereby authorize and appoint Mr./Mrs./Miss. at present workingo 9v . 9 v o 6l
in the position of at the office ofoI
a1ttfiu{ uTel.
lvr:. ....................Rd.
Soi/Lane
n\tAUtnSYl .. 30Ug
Sub-District District
Province to be lawful and legal attorney for the purpose concerning with work permit,
{rnio firirumsl'rrfiunr:rfiurrYunrrraoqcprnvrh'nu o.:u'rruluranor:rl:snaunr:sign any documents on behalf of myself including changing words on the related documents.
?ooqrulnrrvru{trr{rl6qnauiu:urvhuJfi uuurJa.:ufilrfi onrrx"luroncr:el-.:n6imdruWhat has been done by will remain in full force
. , A !s c l Osa 4 ,
and effect as it has been done by myself.
{tr r{rlfi n: vdr m.r4 nil:v n''r?Signed Grantor
d-n{ro............ $ilauCI1u'te
Located onYt , ,ti
Duty Stamp10 Bath
Grantee
Witness
Witness
d .us., o
f i \:t0 ...........e 0..f:Uu0UA1U1aIU
(
Signed
(
Signed
(
Signed
a
f l{to... ytu'lu
?rilTrrlrq nrn{rauriruroil:vc':d'ov.frrYrrlsunr:uoudrurorfluadr.:6u aiounrydrld loslildo,ildrdanrusrudRemark In case grantor perfer to limit the authorization giving to the grantee it could be done by using the other
forms of power of attorney.