AGENT REGISTER
STEP 1. Check Sponsor Agent Detail
Agent ID:
16394
Name:
ธนภูมิ ธนารัศมิกุล
Mobile:
0619979887
STEP 2. Agent Profile
Please complete the form below
Title Name
*
Mr.
Mrs.
Miss
Name
* (English only)
Sirname
* (English only)
Sex
*
Male
Female
Other
Birth of date
*
-Day-
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
-Month-
January
February
March
April
May
June
July
August
September
October
November
December
-Year-
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
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1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
Passport ID
*
STEP 3. Agent Address
Address
* (English only)
Address2
Road
Sub-District
* (English only)
District
* (English only)
Province/City
* (English only)
Postcode
*
STEP 4. Shipping Address
Use address same Agent Address
Address
* (English only)
Address2
Road
Sub-Distric
* (English only)
Distric
* (English only)
Province/City
* (English only)
Postcode
*
Country
Thailand
Lao
Cambodia
Email
*
Mobile Phone
*
LINE ID:
STEP 5. Agent Bank Account (Can fill later)
Account Name
Account No (Bank of Thailand)
Bank Name(Bank of Thailand and fill in numbers only Do not enter special characters)
KBANK
STEP 6. Agent agreement
Agent agreement
I have studied the application rules and Check all the information as true in all respects and click the "Save data" button to confirm the application.
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