Please attach 2 photographs taken within the last 6 months Sx 45 em) Or. Mrs. C1 Miss VISA APPLICATION FORM Ministry of Foreign Affairs of Thailand Please Indicate Type of Visa Requested Diplomate Visa C courtesy Visa Non-lmmigrant Visa rourist visa Transit Vist Na ber of Entries Requested FirstName Middle Name Former Name (any Nationality Nationality at Bisth Birth Place Marital Status Date of Binh Type of Travel Document No Issued at Date of Issue Expiry Date Occupation (pes presen postion and name of employer) Current Address Tel E-mail Permanent Address (ferenstom above) ‘Names, dates and places of birth of minor children (faccompanytng) Date of Arrival in Thi and Traveling by Flight No, or Vessel's name Duration of Proposed Stay Date of Previous Visit to Thailand Purpose of Visit: (] Tourism [] Transit 11 Business] Diplomatic/orticiat 1 Other pease specif) Family Name (nw BLOCK kes) Countries for which travel document is valid__ Proposed Address in Thailand Name and Address of Local Guarantor Tel/Fax. Name and Address of Guarantor in Thailand Attention to Tourist and Transit Visas Applicants Thereby declare thatthe purpose of my visit to Thailand is for pleasure or transit only and that in no case shall T engage myself in any profession ot occupation while in the country. Si Date FOR OFFICIAL USE Applicaton/Reference No Visa No Type of Visa: Ciplomaie vise Clot visn Comtimmigrant visu Cl Tourist Via Category of Via Number of Entries: Csingte Ci poubte Date of Issue Expiry Date Documents Submited Ocounesy visa Oi transit Visa COnutiple Centres Fee REMARK: Applicants are required to pay a visa fee which is non- refundable, regardless of whether the visa is approved or rejected. Authorized Signature and Seal