BOI SV-S-01-01 30/01/2018 Page 1 of 11 Please attach 1 photograph taken within the last 6 months. (3.5 x 4.5 cm) APPLICATION FOR QUALIFICATION ENDORSEMENT FOR SMART VISA “S” 1. Applicant’s Personal Data Mr. Mrs. Ms. First Name Middle Name Family Name Nationality Country of Birth Date of Birth (D/M/Y) Age Passport No. Issued at City Country Date of Issue Date of Expiry Marital Status SINGLE MARRIED DIVORCED WIDOWED SEPERATED Name of Spouse (if any) Nationality Date of Birth (D/M/Y) Age Name of Children (if any) (1) Name Nationality Date of Birth (D/M/Y) Age (2) Name Nationality Date of Birth (D/M/Y) Age (3) Name Nationality Date of Birth (D/M/Y) Age (4) Name Nationality Date of Birth (D/M/Y) Age Current address of Applicant City Province/State Country Postal Code Tel. E-mail
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FOR SMART VISA S 5 x 4 5 cm · PDF file☐ PropertyTech/ UrbanTech ☐ Automation and Robotics ☐ GovTech/ EdTech ☐ Aviation and Logistics ... Copy of currently valid passport
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BOI SV-S-01-01 30/01/2018 Page 1 of 11
Please attach 1 photograph taken within
the last 6 months. (3.5 x 4.5 cm)
APPLICATION
FOR QUALIFICATION ENDORSEMENT
FOR SMART VISA “S”
1. Applicant’s Personal Data
Mr. Mrs. Ms. First Name Middle Name Family Name
Nationality Country of Birth
Date of Birth (D/M/Y) Age
Passport No. Issued at
City Country
Date of Issue Date of Expiry
Marital Status SINGLE MARRIED DIVORCED WIDOWED SEPERATED
Name of Spouse (if any)
Nationality Date of Birth (D/M/Y) Age
Name of Children (if any)
(1) Name Nationality
Date of Birth (D/M/Y) Age
(2) Name Nationality
Date of Birth (D/M/Y) Age
(3) Name Nationality
Date of Birth (D/M/Y) Age
(4) Name Nationality
Date of Birth (D/M/Y) Age
Current address of Applicant
City Province/State
Country Postal Code
Tel. E-mail
BOI SV-S-01-01 30/01/2018 Page 2 of 11
Educational Background
Year of
graduation
Full name of Educational
Institution
City Country Department / Major
Educational
Level
Note: Supplementary sheets may be attached if additional space is required.
Work Experience
Starting
Year
Ending
Year
Full name of
company or
organization
City Country Job Position Responsibilities
Note: Supplementary sheets may be attached if additional space is required.
Note: Supplementary sheets may be attached if additional space is required.
Awards (if any)
Date of award
(DD/MM/YY)
Award Project Awarding
Agency Country
BOI SV-S-01-01 30/01/2018 Page 3 of 11
Please provide copies of these certificates.
2. Type of Participation in Thailand
☐ 2.1) I am participating in an incubation, accelerator or similar program endorsed by a government
agency
2.1.1) Incubator/accelerator/similar program in which you participate in
Name
Address
Sub-district District
Province Postal Code
Tel. E-mail
Contact Person at the program in which you participate
Mr. Mrs. Ms. First Name Middle Name Family Name
Tel ________________________________Mobile
Email______________________
Certificate of Professional Qualifications / Certification of related area of expertise (if any)
Certificate date
(DD/MM/YY)
Certificate name Issuing Agency Country
BOI SV-S-01-01 30/01/2018 Page 4 of 11
2.1.2) Endorsing Agencies
Name and Address of the government agency which endorses the program in which you participate
Name
Address
Sub-district District
Province Postal Code
Tel. E-mail
☐ 2.2) I have received or will receive joint venture funding from a Thai government agency (such as
DEPA) (Please specify the program.)
2.2.1) Details of project
(Please attach supplementary details i.e. project description/project proposal which includes products,