HOI.

TM. 8

APPLICATION FOR RE-ENTRY PERMIT INTO THE KINGDOM

4

LYUUM.........................................................................

....m...........................................

Written at
" 4

Date

Month

?UM..................................LFIBU........................................................................A.PI ............................

Year

EUld

~ ~ n 4 1 U l ~ l ~ ~ l ~ ~ S ~ 1 ~ U ~ ~ l ~ ~ ~ 4

To

Immigration Officer
Y l W L 1 1 ( ~ l U / ~ l 4 / ~ 1 4 f.tlQd?k3
i l a ) .........................................................................................

d "

I,

first name

lIBFl9...........................................................................

(Mr., Mrs., Miss) family name

........................................................................ I ........................... ~nnaun

.......................................

.tla~a4
..............................................................I
middle name

P " d

nationality

age
"

Lmau..................................................... r n.........................................a
month

Ye=

"

years date of birth

............................................................. dSZLnrn....................................................................

changwat
"

I Y

country

oiqw ..................................................................................... i i ~
.................................................
iu~a~n
nuu...........................................................................
* ~ u u ~ ~ u
U

occupation

present address no.

road
"

"

mlua/Llvad......................................................................Q I L ~ L Y F ...................................................................
~
wuan.........................................................................
Tarnbon/Khwaeng

ArnphoelKhet

Changwat

~ o ~ u d ~ m a a ~ ~ ~ m d o n ~ u ~ u " ~ u ~ ~ u ~ ~ . t l ~ ~ ~ ~ ~ n ~ ~ n

,,

hereby apply for re-entry permit into the kingdom

uinn<iu&nf4

Ut.IFlt4

single

multiple
6

~ I W L ~ I U A ~ I ~ ~ T Z ~ ~ ~ F I.........................................................................................................................................................
I~L~~~U~I~~~~T:L~PI

I intend to go to
" d

R ~ u u n o a n ~ ~ n d ~ z ~sun
n r..........................
n ~ n ~ ~mau
..............................................................................

~.rn
.............................................................................

leaving Thailand on :

Year

date

month
d

P ~ U M I............................................................
~
~ w a l...................................................................................................................................................
d
by (mode of transportation)

"

L~azq~nau
and shall return

for (purpose of visit)

4

d ~ ~ r n r n ~ n u d ~ z u i..............................
m

~mau
................................................. :.....................................

A.PI .............................................................................

to Thailand about : date

month

Ye=

u"1=1~~~1?;,4,auld'~a1~u~11~u~B1anfi1~~i~~nuu~~~B~~unl491~4
I hold the passport or travelling document of
vd

" d

d~z~nrn
.......................................................... oanluw............................................................. L ~ Y .............................................
W
amun...................................................

(cou~O)

issued at

no.

dated

ra"

L ~ Q................................................
M
n . ~...............................................
i
a~a7y13mnd9u~l
........................ ~mau
........................................................ n ........................
~

month

Year

valid until date

month

Year

ntdqm6~UhwL~i~~?un7smsaqn~ms7vl~d~aL'iu~7~ds::LnM

,-,

My previous visa for Thailand is of the category of

nua~hno7a

viaado?

nut'iun7.rriiu

tourist visa

transit visa

non-immigrant visa

lu7
others
wd

L.

...............................................................................
QvlVl~............................................................... 9MM.................................. .LmQld

issued at

date

month

A.PI ...................................................

Yea

" d
4
~ ~ ~ W L ~ ~ L ~ U V ~ ~ ~ U9M~Vl..................................
~ ~ ~ S ~ L M
LLil'P
ilM.I..............................................................................
~ M U L U Q
A.fi..................................................
Y

c4

I arrived in Thailand on
w r

un::Imwayq7m1vla

tc4

yos

date
r

month

Yea

aun.................................... ~mau
........................................................................................ n.~i
............................................................

and have been permitted to stay up to : date/ month

year

~7w~ii~o?u~adi7kna7ui7~~~6~ilu~91uq~d~nds:n~s

I hereby certify that the above statement is true and correct

aauwm~n97uGuFia

Your sincerely,

"UILil 4x6 %.U.

4 d

photograph
4x6

cm.

c4

"

~ I u u Q ~ ~ v I ~ Q ~ I U V I ..............................................................................................
~ L L U U Q ~ ~ ~

fi~a

Signature or right thumb print

Applicant

1. ~ ~ a q : h ~ ~ u h i b d a a a ~ q 7 m n " a u m u ~ a d
APPLICATION MUST BE MADE IN PERSON
2.

t
IMMIGRATION THAILAND
$E-ENTRY PERMIT

Number

Valid Until

Number of Persons

u
Number of Entries

Length of Stay Until

CHONBURI
03:-

F i i s s ~ ~ ~ i i ~ ~ ~ n i s 1.000
~ u ~ mn
a a ~d.~vl?u
q-~m
w i d n t d unr: 3,800 Y ~ Y iI7 ~ ~ 1 ~ ~ i i u n i 7 W i d n f d
APPLICATION FEE IS 1,000 BAHT PER SINGLE
AND 3,800 BAHT PER MULTIPLE

3. ~ ~ ? ~ a y q i m v l ? a ~ a i n
q:~:lri"n~uFi7s~su~iiu~~r;i
"m7~

APPLICATION FEE IS NOT REFUNDABLE