form for foreign national_24595.pdf · blood type ... ..... allergies name of hospital currently...
Post on 22-Jul-2018
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For the purpose of No
(Additional) Information Form for Foreign National To Better Serve and Protect This form is to be fill ed by every al ien entering and staying in the Kingdom of Thailand and submitted when request any visa
or other immigration-related service Please write clearly in English and enter date of birth in middotddlmmyyyy(A D) format
1 FOIeigners Name and Surname Nationality
Date of Birth I Age Y~(s) Passport Nwnber
Blood Type Allergies
Name of Hospital currently visit (in Thailand)
Last Date of Entry Port of Entry
2 Foreigners Information in Thailand 21 Address No Village No Soi Road Subdistrict
DistricL Province Tel No
22 Workplace No Village No Soi Road
Subdistrict District Province Tel No
3 Emergency Contact Person(s) 31 In Thailand - Name and Surname Nationality Occupation
Address No Village No Soi Road Subdistrict
District Province Tel No
- Name and Surname Nationality _ Occupation
Address No Yillage No soi Road Subdistrict
District Province Tel No
32 In Foreign Country Name and Surname Nationality Occupation
Address No Road Su~district City
Zip Code Country Tel No
4 Social Media as A Means of Communication from Official (OPTIONAL) 41 Facebook lD _ 43 Email Address
42 Line lD 44 Others
5 Vehicle (IF Available) CarMotorcycles brand ModeL Color
License Plate Number Province
Signed Foreigner
( )
-- 1
For Official Only
1 Information of Recording Person - Recording Date I t Agency
- Name and Position of Recording Person (Official or Private)
Name and Surname Position
Agency TeL No
2 Bank Account Number (Required for Visa Extension Only) Bank middotBranch
Account Na~ Account Number
Signed Recording Person
( )
Position
(This form have been modified by the Information Form for Foreign National Working Group of Immigration Bureau on 18 August 2016 )
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