คําร องขอหนังสือรับรองความประพฤติ APPLICATION …

1 Police Clearance Certificate Center, Special Branch, Royal Thai Police (Thai Identification Card Number) - - - - .. Date Month Year To Commissioner of Special Branch 1. ( / / ) .. (Mr. /Mrs. /Miss) First Name Family Name.

2 Age Years Date of Birth Month Year Nationality - (Name Family Name in English Capital Alphabets) (Marital Status) (Single) (Married) (Divorced) (Widow) Other (Present Address).. (Re ach able Tel Number) ..e-mail/ID (Father s Name ) .. (Mother s Name ) .. 2. (Purpose of APPLICATION , for) ( ).

3 Education Marriage Work Resident Others (Please specify) (Country of Destination).. 3.. Passport / Travel Document Number Issued At .. Date of Issued Month Year Valid Until Month Year 4. (Herewith, I submit the related documents as follows; ) (Copy of Passport) (Copy of House Registration) (Copy of ID Card) / (Copy of Marriage/Divorce) / (Copy of Changing Name/Surname) (Copy of Military Certificate) (Copy of Work Permit) VISA (VISA of Destination) 5.

4 (Others).. I hereby confirm that the purpose of my APPLICATION is already identified in this APPLICATION form and the information given is correct and complete. I also consent to examine all my given information in every circumstance. (For Officer only) .. Applicant .. (..) APPLICATION FOR THAI CLEARANCE CERTIFICATE.

5 (PURPOSE OF CRIMINAL RECORD CHECK).. (FOR DIVISION) ..POLICE CLEARANCE CERTIFICATE (ID. CARD No.).. / (OTHER CARD No.).. (ISSUED BY) .. (CERTIFICATE OF ALIEN No.) .. (PASSPORT COUNTRY) .. (No.) .. (SEX) (MALE) (FEMALE) (FULL NAME).. (DATE OF BIRTH) .. (MONTH) .. (YEAR) .. (RACE) .. (NATIONALITY) .. (HEIGHT) .. (CM.) (WEIGHT) .. (KG.) (SHAPE).

6 (SKIN) .. / / (SCAR/DEFORMED/TATOO).. (CHARACTER TO NOTICE) .. (DOMICILE) .. (OCCUPATION) .. (PLACE OF WORK) .. (FATHER S NAME) .. (MOTHER S NAME) .. / (SPOUSE S NAME) .. (RECORDER) (..)