Record of Foreigner Information

This Form shall be used for making a record o f information of every foreigner who enters into and stays in the Kingdom of Thailand. The record shall be made respecting the notification o f place of stay according to Sections 37 and 38 of the Immigration Act, B.E. 2522 (A.D. 1979), notification of place of stay for every 90 days, application for extension of stay, application for re-entry and review and collection of information of foreign workers.

1. Information of Recording Officer

- Recording Agency:

- Code of Recording Officer:

- Date of Recording:

2. Information of Foreigner

2.1 Foreigner's Name - Surname: , Date of Birth:.

Age:

Nationality:

Passport No ' n ' Name-Surname of Father: Name-Surname of Mother:

2.2 Information of Foreigner Overseas

Address in overseas: No , Village No , Soi/Lanc: Road: , Sub-district: , District: Province: , Country: , Telephone No:

Information of coimnmiity leader (Sub-district headman/village headman) overseas ( i l l the case tlie foreigner is a citizen of Laos PDR, Cambodia, Myanmar or Vietnam)

Name: , Address: No , Village No , Soi/Lane: , Road: , Sub-district: , District: , Province: , Country: , Telephone No:

2.3 Information of Foreigner in Thailand

2.3.1 Dwelling Place: No , Village No Soi/Lane: .... Road: , Sub-district: , District: Province: , Country: , Telephone No:

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2.3.2 Office: No Road: Province: .

. V i l l a g e No , Sub-district:

, Country:

, Soi/Lanc: .., District:

, Telephone Ho:

2.4 All Social Media Used by Foreigner -

2.4.1

2.4.2

2.4.3

Email Address:

2S Vehicle Used by Foreigner ~

2.5.1 Car Brand: , Modei: , Color: License Plate No

Car brand: , Modei: , Color: License Plate No

2.5.1 Motorcycle Brand: , Modei: , Color: — License Plate No

24» Other Places or Premises Visited Often by the Foreigner (such as C b * , Restaurarit, Shop, Hospital and Other Places)

2.1 Persons Who can Contact the Foreigner or Whom the Foreigner WM CtswIwcC When Having a Problem or Needing Help or in Case of EmergeiMy

2.7.1 Thai Person

1) Name: Surname: Occupation:

Dv^^elling Place: No. ., Village No , Soi/Lane: , Road: , Sub-district: , District: , Proviaoe:

., Coimtry: , Telephone No:

Office: No , Village No , Soi/Lane: , Ko@d: , Sub-district: , District: , Province:

, Country: , Telephone No:

2) Name: Surname: Occupation:

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Dwelling Place: No , Village No , Soi/l^ne: , Road: , Sub-district: , District: , Province:

, Country: , Telephone No:

Office: No , Village No , Soi/Lane: , Road: , Sub-district: , District: , Province:

, Country: , Telephone No:

2.7.2 Foreigner

1) Nationality: Name: Surname: Occupation:

Dwelling Place: No , Village No , Soi/Lane; , Road: , Sub-district: , District: , Province:

, Country: , Telephone No:

Office: No , Village No , Soi/Lane: , Road: , Sub-district: , District: , Province:

, Country: , Telephone No:

2) Nationality: Name: Surname: Occupation:

—=^ Dwelling Place: No , Village No , Soi/Lane: , Road: , Sub-district: , District: , Province:

, Country: , Telephone No:

Office: No. , Village No , Soi/Lane: , Road: , Sub-district: , District: , Province:

, Country: , Telephone No:

2.8 Bank Account No. Used by Foreigner

2.8.1 Bank Name: Branch: Name of Account Owner: , Bank Account No

2.8.2 Bank Name: Branch: Name of Account Owner: , Bank Accoxmt No

Note: Other Details (if Any)

(This Form is designed and prepared by ^nHHlBSHnBHHHH^ Deputy Commissioner of Immigration Bureau [Crime Suppression] on March 22, 2016.)

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