Photograph
4 x 6 cm

                                                    APPLICATION FOR VISA ON ARRIVAL

Miss

Mr.
Mrs……………………………………….………………………………………………………………………………………...
                   Family name                            First name                                     Middle name                          (in block letters) 

Nationality…………………………………….………Passport or traveling document No……..……..………...……....   

Date and place of issue……………………………………….………………………..Date of birth…………………….…

Expiry date………….…………………………………………………………..Flight No…………………………….…...…

Occupation…………………….……………………………………………………………………………………………...….

Permanent address………………….…………………………..…………………………………………………………..…..
Address in Thailand………………….……..………………………………………………………………………………..…

Name and address of person (s) of reference in Thailand

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If accompanied by minor children traveling on the same passport, please give names, dates and places of birth

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Signature………………………………………
Date …………………………………………..

FOR OFFICIAL USE ONLY
Visa No …………………………………………………………Date of Issie…………………………....…………………..
Fees……………………………………………………………………………………………………………………………...… Signature…………………………….……………
                                                                                                                                Immigration Officer 
Date………………………………………….…….         

NOTICE
VISA FEE IS 1,000 BAHT PER PERSON
THAI CURRENCY ONLY/NON - REFUNDABLE