Title *

 Mr.   Mrs.   Ms.

Full name *

National identification card number *

Telephone number *

Example: 08xxxxxxxx

Name of legal entity/company/partnership

Legal entity registration number / Tax identification number

Name of person authorized to sign on behalf of juristic person

Position of authorized person to sign

Legal entity phone number

Legal entity email

Full name of the person granting authority

ID card number of the grantor

Full name of the authorised representative

Authorised representative’s national identification number

Authorised representative’s telephone number

Authorisation date

Construction site location *

Land rights document *

-- Select --Land title deedNor Sor 3 Kor land documentNor Sor 3 land documentALROOther

Number/land number/deed number *

Land area (rai)

Land area (ngan)

Land area (square wah)

House type *

-- Select --Detached houseSemi-detached houseTownhouse/TownhomeOther

Number of floors *

Total usable area (sq m) *

Estimated construction value (baht)

Name of Supervisor/Engineer/Architect

License number/professional license