Application Form

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Date ………./………./…………….. Account No …..………………..
Type of Account
Equity Derivatives SBL
Cash Cash
Cash Balance Credit Balance
Credit Balance

Trading Channel
Equity Wealth Manager
Internet Trading
Username…………………….. E-Mail……………………………………………………………

1. Personal data Individual : Fill in (A) Juristic Person : Fill in (B)

(A) Individual
Mr. Mrs. Ms. Other…………….
Name / Surname ......................................................................................................................

Nationality................. Birthday Age years old

Passport Other .............................................

No. Expiry Date ......./......../...............

Address No............................... Building / Village..................................Soi............................

Road......................................... Sub district...............................District.................................
Province...................................... Postal Code
Tel (Home)........................................................ Mobile Phone ......................................................

Occupation
Office worker State Enterprise Public Service
Entrepreneur Doctor / Nurse Professor / Academic / Researcher
Military / Police Students Other

Office name …………….......................................................... Position............................................

Address.....................................................................................................................................................
.............................................................................. Type of Business.............................................................
Telephone.................................... Fax..........................................

Education Diploma / High School Bachelor's Degree Master Degree or higher

Spouse name (if applicable)........................................................................

Office name................................................................... Position............................................
Type of business.................................................................... Mobile phone....................................

Authorized person no yes name.................................. Relationship..........................

Emergency contact person................................................................. Relationship..........................
Address............................................................................................... Mobile phone.........................

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(B) Juristic Person
Name (Eng).................................................................................................................

Type of Business............................................ Company no................................

Country of Incorporation..................................... Incorporation Date........./........../................
Authorized Capital............... Paid up capital…................ TAX I.D. Card No.........................................

Address............. Moo ......... Building / Village.....................................Soi............................

Road......................................... Sub District...............................District.................................
Province.....................................Postal Code
Telephone........................................... FAX....................................................

Custodian (If any) ...………………………………………... ………………………………………………….

Authorized Person ……………………………………………………………………………………………..
.....................................................................................................................................

Authorized person for trading

Name & Surname Position Address Office Telephone Signature
1........................................ .................................... ...................................... .............................. .....................
2........................................ .................................... ...................................... .............................. .....................
3........................................ .................................... ...................................... .............................. .....................

2. Investment Preference

Objective Long term Short term / Speculation Risk Protection

Investment Experience
Equity invested for .............. Yrs. Never
Derivatives invested for .............. Yrs. Never
Mutual Fund invested for .............. Yrs. Never
Level of understanding in investment
Equity Excellent Good Fair Poor
Derivatives Excellent Good Fair Poor

Type of Account Cash Credit Balance Internet Trading

Other Current Brokerage House 1………............................................. Credit Line …......................THB
2………............................................. Credit Line …......................THB

3. Financial Data
Monthly Salary …......…………………………. THB
Other Income (Monthly) …......…………………………. THB Source of Income ........................
Monthly Salary of Spouse (In any) …......…………………………. THB
Other Income of Spouse (Monthly) .. …......…………………………. THB Source of Income ........................
(For Juristic Person) Revenue ………………………..THB Net Profit ……………..THB for ……….(yr)
Source of Other Income ....................................................
Asset (Deposit, Fund, Securities) < 500,000 THB 500,000 - 5M THB > 5 M THB THB
Expenditure / Month (% of Month Income) < 25 % 25 - 50 % > 50 %
Other KGroup product holdings
Deposit Credit Card Fund Credit Loan Others ......................

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4. Bank Accounts : ATS and Interest / Dividend
Bank Account for Stock / Derivatives Settlement (ATS Settlement)
Kasikorn Bank Other Bank ……………………………………………..........
Branch…………………………………Account Type ………………….. Account No……………………….
Bank Account for Dividend / Interest Payment (e-Dividend)
Pay in to ATS Settlement's Bank Account
Pay in to other Bank account
Bank............................................................ Branch ………………………………..
Account Type ……………………………… Account No …………………………..
5. K-Stock 2 Fund (Automatic Stock Settlement via Money Market Fund)
Wish to use the above service
Already have K-Treasury Account Do not have K-Treasury Account
6. Mailing Address
Present Address (as mentioned above)
Other Address ............. Moo.......... Building / Village...................................Soi...........................
Road......................................... Sub-District...............................District.................................
Province...................................... Postal Code
7. Additional Service
7.1 Transaction Information
SMS via Mobile phone no.......................................................... Do not wish to use the service
FAX no. .....................................................................................
E-Mail ........................................................................................
7.2 Market Update via SMS (*with KS conditions)
Yes, via Mobile Phone no. ........................................................ Do not wish to use the service
8. Other Information
Any Ultimate Beneficial Owner of the transaction No Yes ....................................................
Any Ultimate controlling person of the transaction No Yes ....................................................
Currently Hold Political Status No Yes ....................................................
Currently Hold Political Status (Spouse, if any) No Yes ....................................................
(For Juristic Person) Shareholders of 30% : 1.............................. % Hold………… of registered capital
2.............................. % Hold………… of registered capital
3.............................. % Hold………… of registered capital

In past 3 years I and (or) my spouse never violate the Money Laundering Act
If Yes,please identify.............................................................................. Year…………

I represent and warrant that all information submitted above or otherwise in connection with this
Application Form is true and accurate in all respects.
I hereby agree to abide by the prevailing by-laws, rules and regulations of the Securities and Exchange
Commission, the Stock Exchange government agencies, the Thailand Futures Exchanges
the Thailand Clearing House or relevant authorities.

Signature ……………………………………….
(Applicant)
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