rJ :v n r o drrin.r T u rs ndufi n r :fi nutj :vn u fi n ur rfi u r"lrari tt er blA u u u 4 d v d, u i AX d at:0{ fl1:SUdXlfiSnq[A0nUnnAtv{04''1.:[UUenAl{t?Fl:''l?911[t14U{ }ltAU.:[91flY|fl15

ovd 1u n { 1 u rrl m fi ufi n'r :fi nrcl il :v n u fi n rcr ufi u.:"[u]i [?J st lq

vo-Xio,4d6)t(vufi?u ff1un{'turrnvluflnr:dnrcrl:vfl}.]finrcrrfiulluil LIJFr le r.J:valriov:laln:

FtoLaon!na Lv!oo1{tuuanQ1.lt?n:1?9l1tt14u{v!lau{lfiflv!fl1: a'lun{1u11a1"1uyn1:flnuril:vnlfinrgrqU

rfiur"tvri r?m b l:vs;rflwl:vrril todbo lerufi:ruavt6unrirriotrlfi

". r,ir un,rri rfi o vrir ufi unr:{r.: uavri r{1{dt6'Yu

(o) dn:r6'rrrirrr:m sitrvri$rf;'aqdnfinr:utYdld

G) dm:rrir6"r{r6ouav c(,ooo u1il riotfiou siruru u o'm:r rJfrrifimufil:rriuulu#qrYgl

drfnnurumfr ufr nr:fr nrctJ:vnlfi nrgrrfi uflr.lri nor to 6 osdry 9o. Ll{LlUUU1U14UO{Ln5<dvv

Ie. LT{nuu?otuJttnouou

*. T:sriuutarj:vyrurfl ourni nrr6:rBier{s d v t<vd. L:{t:uuu'tutt}JLa

a. I:rGauriru#unats d u ',*b. L:.tt5uu!1u1llm')

va j rf , va o s o r gda a ub. q 6udxru ervr ? tu rra un fuduu et ray{1 ud1}1:u9l'l u14u{ u0 { HtJ 6iy ddsJn:vooiv.lo.o Fl6UdlluflYl?[U

v v Y 4 -^ - q , - t u ,3,iailFt:9t0.i1.ln6uailunu? LU o.ir)0 LUUsi

/ , du aU(o) LlfiQlJ'lFlLvlU

(to) fi or qhimir n'ir rro fl u3q:ni fiu fi qiuarTnr :iua ofr'r u

(*) hJ r{Juqneafrrlava'ru

(a) hj r{l u (fi n r u v vw,r a n l v! a utila 1 :l :nr.J fr rifr urir fi16' tirr r rlr a'rln : n ui o^"-ld.r,t.-6orrlurfllou hialrl:vnou vrioriJul:ner'r:Jfiri'ryuntflunXrarru'irrira:vrfiar{r:rrnl:y,raLiou

/e, U td, yo y 4 4 d\c) L3.it!U0.lO'l:{0l'ltt14U{lJ'l:'ttn1:n1:t3.t0{ n::iln't:V!::nnt:t}.tO{U5Ouv!p.d

ta luulyr Lu?\:: Ft n'l: tl.t 0{(*, , t

" u e o, s,,') iri r{J u {ur u 6'o r irTvrudr q nTn u rirfi vn nrgr fi r ii q nl#dr q n rv! : 1 u n : u li'l

avrd,souoiuyosFt?'u.Jfrqu't{ortU't tiuurirtJulvrrc6irvirnrufrofrtoin:vlirloul:vrruraioFtxl}.tfrqayIilu

9

(o) tri lfl u{rn uqnalliluhi'oo n rlarroo n vriotrioonaln:lrnr: Ygiarrafi odrd-

14:014U? U {',tU0U"lJ 0.i :5

b.b n 6u6uJri6 raylr sdrr,tYu si'uuiltI

(o) rir r*o nr:fi nrgrqYurTo erl fi nrgrfl fi r,r n (1. u) fi utrjI

d, vdo d a \yrb) tlUrilQnA'Io'l:ily :n{lUU:nl: LtAUAll]'l:0atLAtonv'ln1:LO

alLnoauv:1u

01m04u11:'ru

almoauv:'tu

01m0auil:'tu

01m0v!:'t?

01tfl0tLl.J:tJ

-ls-

, i o!6n. 1.r oud't u lrufi o v-tdrJfr rifi

q o ,i3 d a qY I 4 u d a dtJlUnlrULUgirttVtUlVltaU.iLftnl^ln1: LUnl:OLtA tlULuA0UntiUUfln'l5L:UU5?:.1

viJ itta v!fl ! rlvulvl 0uvl1.lo1114:.1 1 u

vud. n1:5uailn:

d.6, iu t?41 ttaudn,ufiYudlin:

fr'r.J:vaqriovarin:r{rYunriL6on 6u"Lua:jn:rirurruto{16'fi ncillivr:l'tulJnna-cq

o v i .j d | € 4 6t-!.-.,., -.--^,^-^-

i .--.--..dtufl{luttnfluynt:dnurrj:ynlfinrgrrfiulluri tflrt l€) :vv'ix iufi d - ob frnuruu bdbo(Luiu nar :1rln1:)

- Ay Ad.b uanfl 1uilao{uuv{fouluarinr:4

(c,) :l rir uvfir n :t triarrLul': n tta vlila?[.J t[']uFt'tet1 lJu'trt, Z o u tr r a 4 ,u 4 L

rir u nir ud ur rTuhi rfr u b t6ou (riu illiutl fl :-ua:in:)

(to) 10fr nr:finul uto rafiifi oYl:o.iqru?efr

(*) eir rurrin:rl :vsirfr'rLl:vt1{uody(d) alLulvlvLuuulJ'lu

(a) hYl:o.iuvlvd- i ,v d.(b) vlan51u0u ''l (01]J)

u6'ngrumu{o (b) - (u) l#rjr ri'uarilq3.:ilr rfi o Fr:?a ao! uavdl tu1 Lo nar:

vr n arirtri'r,ia fln : rfi rr u rir Yr : o r a"r tu li r a n fr o t tua v a I d o rir riul{6'r a1!u

d. n1:ilrunT o:ru{i0frfi tvrdr{rYunr:do u6onU

rvl:vnro:ra{ioe.Tfifrvrdr{rYrnr:finrf;on nru"Luiufi bo frnuruu bdbo!1

frnl:vnrn ru r{rrinrrurrndufinr:finrgrr.J:vn:rfinrcrrfiurlvri rtn b uau?r'r.iL':ltclg{ tordrfintrut'um3id,drfr ufr n r : fr'nrgril: v nil fi nrcr ifi u rlyri rr m to http:/www.cmlq. go.th

u. ra#n rn ruviua viBnr:6'o 16o n

drrinrrurtndufinr:finrgril:vnrfinrgrrfiurlyri rrer b avrirrfrunr:6ntdonToui6nr:aor

#unrrsni ufiofior:rurn?'rr.rrv:rual1u6'rurix t t6'uri nrrlf,firflul:vlutrilunr:r.Jflrifirruru

Fr?''rl.ia11.i1:flr.J:varnr:ai raanfrrav!ofrnnrvrlunr:rJfrri6rru luiufi tele frquruu lodbovt1

ru ri'onJ :vrpdrfinmu rr mfi ufi n r:fi nrgrl :s nr fi nrcr lfl urluil rr n te

s'y. tJ:snret ru a n'r:6'q tA a n

qvl:vnro:rudorir.irunr:rinr6on nru"luiufi IEsn frnuruu lodbo frflil:vnrfiou.Yi',otq

ru a'run{ruLlJerl,{uun"r:finrcrl:vn!finrcrrfiur"Luri rrn to rrauu'r.rr?llclri rorr{rfinrrurrlndufin'r:finu'r

il:vnrfinurrfiur"Lrari lrn Io http:,/www.cmrs.go.th loruduriryfirirunr:n-rrrf;onteir{lurrar t, fl

or U")

Q',tu?l] en

Q'IU?U O

Q'IU']U O

Q'IU']U O

x'lu?u o

Q'IU?U O Q

:la!ua!uAUU

a!!11lJ

(

d. n1r6'ariT f,'rurur{T triairunr:fiq rf; on9U U

d.o ririrunr:r-l:vrfruriTn-rfi " fi.r u ovtei:-rnr:6'ndr#rurur6'x fi'lrrdiufi rruU

frnurau bdbo fir *o riuuruu bdbo lnaovfinr:rirrfiunr:rjo#ruq,r6'rltleioti ridriofio,i

rirrfrunr:rio#ryryrl6'firiorfioteiirnr:6'ora::rtuorndrrinrrunilun:::.rn'rrnr:finrcr?Yufirgl, rrfrrrvitiu

louarrrr:ntfin6'xt6'rarntritri'Yl{'oa::tiuornr{rrin{ruPrtuvfl::unr:nr:fin*'.rrirfirq.u4v v - o ' .j i d a 4 tdY i .j o { , '

d.r.e nlTa"l.iqndxdrrr:rroi'r*uurfrraarrrrnlrnr:L:riltorynnua0tu0{vlsuurL!an1:!:Tn

ra6 o rl Yu uJ f; u u a fl 1 u n 1 v\ rfl u a n 6'r rrj : v s;r/fl #nl r u : r t n r : ui o rir : 1 fl n 1 T

x. zua nr:6n rf; onr or nruv n::r nr: fi o ifl rfi duq, {a:irr:fio 16o nratoq n rra duo v dn drutiltfiurrsLil?'rni[uLo'l

< I 6ty I u ua{!:vn1fl Luvr:11J Lfi uv'lnu

r]:vnrrt il V'|.fl. leldbo

tol{rirurunl:drfincruttEr{udnr:fl nu1 inu1tl{nlttl?lu

fidrurunr:drfnqlu$flfrudn,r.ifi nutjrcnranurtduEluri t$n 2I

-a 4q

?UYl or tPlOU }.jflU'lUUq

(u,olfinra rdourvru)

io v[a?Jvr [udiln:..................

@ u A u 4 d, v i o , i3 d a[u d il n : tv't 0 n q [a 0 n tu u a n o 1.: tJ ? Fl : 1 ? 9l''l tt14 u.1 v{ [a u { t9l fl y{ n 1 :g

os.!o14,.!dodt u n I ru tt 9t v,t uvl n 1 : rl n u1 U :u n :J Fl n u1 [?J u.: [14 u tu gl lo

ta.r( t( t( * ta x x x * * * *.r( tt * rt * x * l+ l( * * * * * ta x t( t* * * r( ta * x x *,4 ta l( * *

A u d-ia t \ Y a 4r!oiLil:r{fvrvrri0f01o............... ......?ellnr:fnu1.....................?f'l[0n...

d , ci v v u o 4 J o v AAX d a o u X Atnrurj:va{Flylavailn:tu't:ufl1:noLa0nLLaua::v'tt?\0vt't14u1vlvrLau{tnnY{n1: a1ufl.l'luLflniluvl

n1:6nu1il:vnrfinurrfiur"Lyri rrm to r,rio:rfi16'uulva-n5rul:vn0!nr:;Lral-n: 116":urild

(

(

(

tra:Yn: siru'ru o arir

air rurvrv tl'uuriru

) luiu:orrurnruri

()

()

()

;ir ru rrirr :rJ : v sir 6'r | : v r rru

alLu'rnt:?Brnl:flnulI

a3 I 6!1...'...".........

,.rauFl:

va-nf,''ruliln:!

qYt v oLUA{vafl fi 'ruL?\Lr LFtLr

d

( a{10 )

?uvr tFlOU l]nLlUU fl.fl. IEdbo

v<yuA-vu uil n t0 114u1 vl TUd xl Ft :

16' m :r o a o r q i! a :r !-fr rLa u r o n a r : rljo r 6'u udr rJ : r n n'j r

o uanorun:rfiru o

q Yu u \ Vo Lu:uailnrLo o

d[uun?: