lluu 9rvl. dFORM WP. 5

loll13tn1r,ru1ll

FOR OFFICIAL USE ONLY

tat:!11 .. . . . . . .

nlun150n14'r.l1uDEPARTMENT OF

EMPLOYMENT

nt! 5'l{u:{{1uMINISTRY OF LABOUR

rirro siooruluouflJrsly'rr1u

9t1lJUln:1 bm

APPLICATION FOR A RENEWAL OF A WORK PERMITUNDER SECTION 23

o0nLv

14r 1 U tAflU:J 010r? Fr1.l0r1{n',l'l

ta{anun1{n'r?Atien's lnformation

Name of appticant Mr./N.4rs./Miss

1l

Year5Nationatity

r.z doalurj:vrrnlvruDate of birth Age

Address in Thaitand No.

vrivr-/or n r:Moo,Euitding Soi

0x,Iu............ ............. ......................... ....... ...9i't!a/$r?.i m a,/ttTambon,/Khwaeng Amphoe/Khet

Changwat Postcode Tetephone

Facsimile E.mait address

1.3 ro nd'nran{ nr:!i'ir o r4 rgr m1fi'o q1u: r t o rrur o-n:sd r':lfl a dr':vdr ol siolUdDocument showing a permission to 5tay in the Kingdom as fottowsl

(1) Ll r4u{a0tnuvl1{

Passportd ovd

14111......... .... ........ ......... ........ ........ OOn LyVt

E ra nar:lt'wuufifr oro'uvrrrDocument in tieu of passport

lssued at Country

oo n'tDate of issue

n:?Qa.1n:''tu:vType of visa

Vatid untiL

ooflloate of issue Vatid untit

tol.lvrli 'ro.r:1901 1nn5Date of anivat at the Kingdom

Having received a permission from an immigratlon offlcer at the immisration checkpoint

hi'ou'lu:rtorruli"n:To be abLe to stay in the Kingdom unti(

(zl tu61nqJoull0qCertificate of permanent residence

t4111

NO, lssued at Changwat

oon t14'tuv1......... .. tDate of issue,^ , O a w

' c w(3) LUAlnqU:vArn?nUn1{01?

Atien identifi cation card

Valid unti t

onl 0.ll.it't I

lssued at Changwatq'aa o 'J l 'v4oa

oon tutuvl.. ..... ........... ... ...111Lfin,rluvrDate of issue

hor.lqrwirrruratfiWoft permlt No.

Vaiid untit

7.4 00fl11,114

lssue at (Changwat)

oate of issue

flaulFtn't.t

Vatid untiL

Name of emptoyer

vtou tatvl ltuv[/a T

Address No. Moo/Buitding Soi

cirma/rr0r............

Amphoe/Khet

ou!..1................................. ...............................0i't!a/tt

Thanon Tambon^hwaeng

oivin.. ...... ... ........... .... .............. ... :v-a!J:uniri ......... ....Ivr:6'nli Iv:ar:Chanawat Postcode Teteohone Facsrmrte

2. dolanr:toourursrApplication lnformation

lracia ar ulr rnun rrovirsrr.r ! l LOatl 1tr

Year (s) Month (s) Day (s)

from

nufl .11u11 .......................to

Afpty,for a,renewat of a work permit for

fl{ttn?uvr.........................

3. rondr:uac anoruoocuments and Evldences

X e w\v4 . - "a,3:o nltou 1l'l lIti1 lfiuu[on615[[acuan5'tuo.lgl0 tllu

Together wlth thls app(ication, I have attached herewith the foltowin! documents and evidences:

71 l l l t rnt rnr , lEl

Work Pe.mit

5.2 L_.1 Altulvu tA0touvrl.l 1rt0a^^v

^f ^i.c^^.t ^r

Ll a1LU1t0flAltL{tLvtUlrU{AALOUVI'].I 1410

Copy of document in tieu of passport, or

! rirrurluzir6'rgtl:viirn'rnrrir.rdtuavdrrurhrirdry6udodCopies of A(ien identification card and Cediicate of permanent residence.

3.3 tr eirlurra6'n unr:aururnbiuilnlu:r{o'rfu1n-n:Copy of evidence of permission to enter into the Kingdom.

3.s n:fiuru{'xrf,uunaao::uo1

3.4 fl rarirflo:-u:ornr:6'r{to{fidiocrfluur0i'r{nu:culuelriadtrii'r,:unnaairutrfrlyulir.rruviiolri'rya'nmur.J:vnoI run r.l an'l nd rrWork recommendation of a prospective employer descnbing reasons for not empLoyng a person of Thai nat onatity to work, together

wth supporting evidences.

ln case the emolover is a Naturat Person

! rirtlrrin:rl:viirsr'rl:vtrtuuasa'rrurvrvuluurirurovi6ravrtjuuru6'ri uioCopies of ldentification card and house registration of a prospective emptoyer, or

AUJLJ A1[U',r14U{60LUl.JylT. l10.tf t{ . inVtUUUlUn1.i 1, 'r50

Copy of Passport of a prospective employer, or.J

L_.1 dTlLJ'rLUdIFrUnU110U10rtJ{. in3r1JUU1LnT{

Copy of Certificate of permanent residence of a prospective emptoyer.

n: u1uo1.!tuuununnaIn case the emptoyer is a Juristic Person

! riturtanar::-l:o.l?oriiru:rtnr:dFsrdaruraowjrfionr:ror{firovrihuru6'r.r'ldnnflvrirJuvrioldiuorlryrnlrii'nfiittavo'rufiulrulqonndolrrunnrarru Iflu[Laol ryrnv]firnr:drsCopy of Cert fcate of a re(evant Government agency stat lnS the business of a prospective emptoyer has (eqatty been

registered or granted a l icense to estabtlgh and operate, and the type of buslness has been 5pecif led.d.d J ,

n5fuulgaltun al[u'tu:anu ouuontlta']fu10n:In case the emptoyer has permanent residence outside the Kingdom

! rirrura'rgrgri'rrtvrr viaCopy of setuice and/or opention contract, or

a4u a1[u1aqlru1{01j1u 1450

a^^w ^f

<)16 .^^rr , . r ^r

! rir rur ro nar:dufi uaovir riduri'r,lofi nrrriir iflud'ar lriurlirrrulu:rtorrura-n:(ru!).......................Copy of other documents showing that an appticant has a necessity to work in the Klngdom.

Gpecify)

n: ulJ u1uo1.r

nIn case of without an emptoyer

eirtrrtanar:duanvirridurirtor{Jul.ifinrlrLiuay:ca!nr:nirurrydrnirrrufitoiuluoururn\ id l / . . . . . . . . . . . . . . . . ,

Copy of document showing that an app(icant has a proper knohiedge and expeience for engaging the work

(specify)

n ririura'ryrgr{rluarr r.rioCopy of service and/or operation contract, or

J4Ll a1t!1afrni1flal1a u50

.^^,, ̂ , .] '. -^'-., -tr ;ir turtonar:dufruaovirlidurircrofinruo'rr{lu6'ar lriurrir.rrulu:rtorruro"n:

Copy ofother documents showing that an appticant has a necessity to work in the Kingdom.

(spec ry)! a'rulrholrprn :v n oro: fi oor u n 6urLr a'jrdr u nrrl:zno!o: frnro{ n u qir.i qir':h n:nifr rflulru

fi aeinra'tdl"rniun4yrLru'jrdrsnr: :gna!q:nlro.rnuriln6'r')Copy of Business operatins l icense under the law on atien business in case that the work apptied for is under such (aw.

3.6 tr luiu:o.rto.rai{:vnoritrfinntn::rnrlnnrarLru'ird'ruitrirntn::r fiir.r:avirddun'rtoLirf,uunna?nan:nr,t:ouoefiurfiou'biarnJ:vnouuavl,rittul:nsrrilvltniuunlilunnn:ou:r.rdrosn".r,n?.llltutJln:'l oo

Certificate ftom rn€dicat practitioner under the taw on medicat treatment professional stating that an applicant

is not a person of unsound mlnd or suffering from mentat infirmity, and is free from any defecti as prescribed in

Ministedat Regutation issued under section 10.

y s ; I I11 tn't10fu:0{1110n't'ttJl't{nuutljun?1tJQ:{vtnuf vn't:I hereby certiry that the information given abwe is true in ;/ery respect

' la1urat0......................... ..........,...................4tJ1]n'ltt)

FOR OFFICIAL USE ONLY

n1: n1:ru1n110e e4

o. n?'rtJluutJ0{11un{1!lQ1t4u'l1l

u4 u Iuuufi u.: a 0 :u :0 { n 1 :{ 1.r

FORM OF EMPLOYMENT CERTIFICATIOI{

1. riouaulgdrr EMpLoyER's TNFoRMAToN. . . . . . . . . . . . . . . .1l1yl

THAI ]URISTIC PERSON REGISTERED ON NO. PAID UP CAPITAL BATH

u'rvrFORIEN JURISTIC PERSON REGISTERED ON THE AIVOUNT OF MONEY IMPORTATION

NATURAL PERSON ID.CNRD NO. U/ORK PERMIT NO.

:raki flrqiu.......... ..............u'm 'lurirr:cuvrrar................................ 16ouTHE RECENTLY NCOME BAHT THE DURATION N4ONTH|J } lnn,1n'156.1000 THE VALUE oF EXPORT ... . . . . . . . . . . .U', ' ]V1 BAHTr - l v. ilJ lsirirnusrxrj:vrvrqrrrurvorrfrsrlu:0uifrairurlr....................... .. .@u

THE AMOUNT OF TRAVELLER IMPORT FOR THE LAsT YEAR PERSON

E finu"n.rrundyu rHE AMouNr oF rHAr woRKERS........................Fru pERsoN

D fi nusirseirrdlgudreradudr..............nu'houru1enillll1atfr ............THE AMOUNT OF WORK PERMIT HOLD€RS WORK PERMIT NO,

E o'rurur.ialliau rHE AMouNr oF RooMs..............ri0.r noo,r,ls E i'rururinuiuu rHe nr\4ouNr oF sruDENrs...............nu pERsoN

2. daranr:drr TNFoRMATToN oF EMpLoyMENT

11T'/[i1U5VA{nn3nl{nlJnlno']1to I DESTRE TO EMPLOY

flotrfr uroneurv. vlIafifl erooo cnoup....-..

fit.rvu luurvnnu6uv{1u .oB DEscRrP-roN.........

tvlldf 'tu?]111.i'r1.J 0Mnn1ltu.itt14.1

:vL3r'ra^1'r:0'1:..................1J..............|f '01.J.............11.J U A qJ qJ 1n ̂. i fr i11.r11PER OD OF CONTRACT YEAR MONTN DAY CONTMCT VAL1D UNTIL

eir6,r ly5o:ru1r i , iuay/t6ouac. ' ' . . ' ' . ' ' . . ' ' . . ' ' . ' . . . ' . . ' ' . . ' ' . ' ' ' . ' . .U1y]arar] :c1Ut{6! iuav/t6ouag.. . . . . ' . . ' . . ' . . . . . . . - . . ' . . ' . . ' ' . . . . ' . . . ' . . ' ' . ' ' ]uWAGE OR INCOME PER DAY / MONTH BAHT OTHER BENEFIT PER DAY / MONTH BAHT

:voiunr:6nurq.r4o .................rJ:caunt:ni1ir.rru................fl anruntr E Tao E arl:aTHE HiGHEST EDUCATION ]O8 EXPERIENCE YEAR STATUS SINGLE MARRIED

3. $rEruafilrid1{qflnaa'rytrfihunitir{ru rHE REAsoN wHy Nor ro HIRE THAI pERsoN

" &" - :t{50!U L0UU!r4Afli'l!Ulv nOU[14911{Af]nna1lo1g U.!U I E|ICLOSE HEFAMIH TNE FOLLO\{'I|G DOCUMB.ITS FOR 9JPPORnNG THE ASOVE RF}S0\1;

, e Xa{rntirtail:o.lir {ofr?t tirnt,tiliiuni'rlln3lumj:vn't: I HEREBv cERTIF/ rHE ABor'E trAlrMENr ARE rRUE rN EVERv REspEcr

1.2 a01ucailufl1itiu "Lu:otflfidruur rHE FTNANCTAL srATUs oF THE LAsr y€AR

U V{.FI.

YEAR

fluvi51,! u

ASSET

:r uld'INCOM€

tiuaor/riuahnournr:CASH/DEPOSIT

rirt:/tr erluPROFIT/1055

t'1u1r5uytTAX

rarLranaq {lillfi6oil:ord ovd'o*ilu{fidrurrar6orynn'uaflru lrnorlnl: viol6':nraldruralfi'rirnr:uvr:REMARK THE PERSON SIGN THIS FORM MUST BE THE AUTHORIZED DIRECTOR OR AUTHOR]ZEO REPRES€NTATION

Power of Attorney?luf 6[A3JAUO1U1e

Duty Stamp10 Bath

01n?r[f loo ll']Yl

Written at

1t'111

Date Month B.E.VA' tuvt ................ Io0u .......................... v'r.f[.

l. Mr./Mrs./Miss.{ryr rit uru/ur,:/ur.:dlr

hereby authorize and appoint Mr./Mrs./Miss.

rtororriruro"hi u1u/u't,t/u1{fl 'r?at present working

rlooriurir,:rulujn the position of at the office of

airuyri.r ................ rf.':orifiritin.:ru60 ................Tel. Located on Soi/Lane

Rd. Sub-District District

Province to be lawful and legal attorney for the purpose concerning with work permit,

{.:r.rio .................... r'eirurooi lfiunr: rfi lr fi'rnr:raoururndrmu oturl"lu ron or:l:;no!nr:sign any documents on behalf of myself including changing words on the related documents.

raorlryrnumu{rnrdrldqnarir :r:.lytv.ll!fiuuulo':ufi-ltflanrrrlluranor:d'.tnaimdruWhat has been done by will remain in full force

and effect as it has been done bv mvself.

{rn rirldn:yrir ro{rn!i:nrlSigned

fl{6o ....................... ti atlohure

( . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . )

Sjgned Grantee; -- "d{ra . . . . . . . . . . . . . . . . . . . . . . . $tu}J01j0 ' tu1a

(. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . )

Signed Witnessj

d. l t0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . l lU1U

(. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . )

Signed WitnessA

o$t io . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vtu ' tu

( . )

fi tarvn rnfitJa!rirurorl:vai6evsirfi'o1o)rnr:rJa!firulq rfluodrJdu eiorn::vir'ld lorieifia{tdrdan:rrJorrildRemark 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.

Grantor