คําร องขอหนังสือรับรองความประพฤติ APPLICATION FOR THAI ...

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.)

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