รวมระเบียบคำสั่งกรมที่ดิน ประจำปี 2553 (ส่วนที่ 2) (ปี 2553)

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∑’Ë ¡∑ ıÒı.Ò/«. ÛÛÙ °√¡∑¥’Ë π‘
»πŸ ¬å√“™°“√‡©≈¡‘ æ√–‡°’¬√μ‘ ¯ æ√√…“
ı ∏—𫓧¡ Úıı Õ“§“√∫’
∂ππ·®âß«—≤π– °√ßÿ ‡∑æœ ÒÚÒ

ÚÛ °—𬓬π ÚııÛ

‡√Ë◊Õß ·®ßâ √“¬™ËÕ◊ ∫√‘…—∑∫√À‘ “√ π‘ ∑√æ— ¬√å “¬„À¡à

‡√’¬π º«âŸ “à √“™°“√®ß— À«—¥ ∑ÿ°®—ßÀ«¥—

Õ“â ß∂÷ß Ò. Àπß—  Õ◊ °√¡∑’Ë¥‘π ∑’Ë ¡∑ ˜Ò/« ˆ¯ÙÒ ≈ß«π— ∑’Ë Û ¡π’ “§¡ ÚıÙÚ
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øî≈≈‘ª å ®”°¥— ©∫—∫∑Ë’ Ò/ÚııÛ ≈ß«π— ∑’Ë Û  ß‘ À“§¡ ÚııÛ

μ“¡Àπ—ß ◊Õ∑ËÕ’ â“ß∂ß÷ Ò °√¡∑¥’Ë ‘π‰¥·â ®ßâ ∑“ߪؑ∫—μ‘„π°“√®¥∑–‡∫¬’ π¢“¬À√Õ◊ ‚Õπ
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®¥∑–‡∫’¬π‡ªìπ∫√‘…—∑∫√‘À“√ ‘π∑√—æ¬å ·≈–‡ªìπÀ≈—°∞“πª√–°Õ∫°“√¢Õ√—∫ ‘∑∏‘ª√–‚¬™πåμà“ßÊ
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 àßæ√–√“™∫—≠≠—μ‘·°â‰¢‡æ‘Ë¡‡μ‘¡æ√–√“™°”Àπ¥∫√‘…—∑∫√‘À“√ ‘π∑√—æ¬å æ.». ÚıÙÒ æ.». Úıı
¡“‡æ◊ËÕ∑√“∫·≈–∂◊ժؑ∫—μ‘„π à«π∑Ë’‡°’ˬ«¢âÕß ‚¥¬„π°√≥’∫√‘…—∑∫√‘À“√ ‘π∑√—æ¬å¢Õ‰¥â¡“´Ë÷ß∑’Ë¥‘π
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∫¥— π’È ∏𓧓√·Àßà ª√–‡∑»‰∑¬·®âß«“à ∫√…‘ —∑ ∫√‘À“√ π‘ ∑√æ— ¬å ≈π‘ πå ø≈î ≈ª‘  å ®”°¥—
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¿“æ∂“à ¬„∫∑–‡∫’¬π∫√‘…—∑∫√À‘ “√ ‘π∑√æ— ¬å¢Õß∫√…‘ ∑— ∫√À‘ “√ ‘π∑√æ— ¬å ≈π‘ πå ø≈î ≈ª‘  å ®”°¥— ©∫—∫∑Ë’
Ò/ÚııÛ ≈ß«—π∑’Ë Û  ‘ßÀ“§¡ ÚııÛ

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 ‘π∑√æ— ¬å ≈π‘ πå øî≈≈ª‘  å ®”°—¥ ¡“‡æÕË◊ ‚ª√¥∑√“∫·≈– ß—Ë „À‡â ®“â Àπâ“∑’∑Ë ¥Ë’ π‘ ∑√“∫·≈–∂Õ◊ ªØ‘∫μ— ‘μàÕ‰ª

¢Õ· ¥ß§«“¡π—∫∂◊Õ
(≈ß™◊ÕË ) Õπ«ÿ ≤— πå ‡¡∏«’ ∫‘ Ÿ≈«ÿ≤‘

(π“¬Õπÿ«≤— πå ‡¡∏’«‘∫≈Ÿ «≤ÿ )‘
Õ∏‘∫¥°’ √¡∑Ë¥’ π‘

 ”π—°¡“μ√∞“π°“√∑–‡∫¬’ π∑¥Ë’ ‘π  «à π¡“μ√∞“π°“√®¥∑–‡∫’¬π ∑‘ ∏‘·≈–π‘μ‘°√√¡
‚∑√  ÚÒÙÒ ı˜ˆ ‚∑√ “√  ÚÒÙÛ ˘ÒÚÙ

˘Ú¯

˘Ú˘

( ”‡π“)

∑Ë’ ¡∑ ıÒı.Ò/«. ÛÒÙı °√¡∑Ë¥’ ‘π
»Ÿπ¬å√“™°“√‡©≈‘¡æ√–‡°¬’ √μ‘ ¯ æ√√…“
ı ∏—𫓧¡ Úıı Õ“§“√∫’
∂ππ·®ßâ «—≤π– °√ÿ߇∑æœ ÒÚÒ

ÚÙ °—𬓬π ÚııÛ

‡√Ë◊Õß √–‡∫¬’ ∫°√¡∑¥Ë’ π‘ «“à ¥«â ¬°“√®¥∑–‡∫¬’ π ∑‘ ∏‡‘ °¬’Ë «°∫— Õ ß— À“√¡‘ ∑√æ— ¬´å ß÷Ë ‰¥¡â “‚¥¬∑“ß¡√¥°
(©∫—∫∑’Ë Û) æ.».ÚııÛ

‡√’¬π ºŸâ«à“√“™°“√®—ßÀ«—¥∑ÿ°®—ßÀ«¥—

 ßË‘ ∑Ë ’ àß¡“¥â«¬ √–‡∫’¬∫°√¡∑¥Ë’ π‘ «à“¥â«¬°“√®¥∑–‡∫’¬π ∑‘ ∏‘‡°¬Ë’ «°—∫Õ —ßÀ“√‘¡∑√—欴å Ëß÷ ‰¥¡â “
‚¥¬∑“ß¡√¥° (©∫∫— ∑Ë’ Û) æ.». ÚııÛ

¥â«¬°√¡∑’Ë¥‘πæ‘®“√≥“‡ÀÁπ‡ªìπ°“√ ¡§«√·°â‰¢‡æ‘Ë¡‡μ‘¡√–‡∫’¬∫°√¡∑Ë’¥‘π «à“¥â«¬
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μ“¡√–‡∫’¬∫°√¡∑Ë’¥‘π «à“¥â«¬°“√®¥∑–‡∫’¬π ‘∑∏‘‡°Ë’¬«°—∫Õ —ßÀ“√‘¡∑√—æ¬å´÷Ë߉¥â¡“‚¥¬∑“ß¡√¥°
(©∫∫— ∑’Ë Û) æ.». ÚııÛ ∑’Ë ßà ¡“æ√âÕ¡π’È

®÷߇√’¬π¡“‡æ◊ËÕ‚ª√¥∑√“∫ ·≈–·®âß„Àâæπ—°ß“π‡®â“Àπâ“∑Ë’∑√“∫·≈–∂◊Õ‡ªìπ
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®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡‡°Ë’¬«°—∫∑Ë’¥‘π·≈–Õ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕË◊π ·≈–Àπ—ß ◊Õ√«¡√–‡∫’¬∫
§” ß—Ë ‡°¬’Ë «°∫— °“√®¥∑–‡∫¬’ π ∑‘ ∏·‘ ≈–πμ‘ °‘ √√¡ ª√–‡¿∑°“√‚Õπ∑¥’Ë π‘ ·≈–Õ ß— À“√¡‘ ∑√æ— ¬Õå ¬“à ßÕπË◊
‡æ◊ËÕ„À â “¡“√∂„™Õâ “â ßÕ‘ß„À∂â Ÿ°μÕâ ßμ“¡√–‡∫’¬∫∑‡Ë’ ª≈ˬ’ π·ª≈߉ªμàÕ‰ª¥«â ¬

¢Õ· ¥ß§«“¡π—∫∂◊Õ
(≈ß™◊ËÕ) Õπ«ÿ ≤— πå ‡¡∏«’ ‘∫Ÿ≈«ÿ≤‘

(π“¬Õπÿ«≤— πå ‡¡∏’«‘∫≈Ÿ «≤ÿ ‘)
Õ∏∫‘ ¥’°√¡∑’Ë¥‘π

 ”π—°¡“μ√∞“π°“√∑–‡∫’¬π∑Ë¥’ ‘π
 à«π¡“μ√∞“π°“√®¥∑–‡∫¬’ π ‘∑∏·‘ ≈–π‘μ°‘ √√¡
‚∑√. ÚÒÙÒ ı˜ˆˆ ‚∑√ “√  ÚÒÙÛ ˘ÒÚÙ

˘Û

( ”‡π“)

√–‡∫’¬∫°√¡∑’Ë¥π‘
«“à ¥â«¬°“√®¥∑–‡∫’¬π ∑‘ ∏‡‘ °¬Ë’ «°—∫Õ ß— À“√‘¡∑√æ— ¬´å Ë÷߉¥¡â “‚¥¬∑“ß¡√¥° (©∫—∫∑’Ë Û)

æ.». ÚııÛ

‚¥¬∑Ë’‡ÀÁπ‡ªìπ°“√ ¡§«√·°â‰¢‡æË‘¡‡μ‘¡√–‡∫’¬∫°√¡∑Ë’¥‘π «à“¥â«¬°“√®¥∑–‡∫’¬π
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®¥∑–‡∫’¬π ‘∑∏‘‡°’ˬ«°—∫Õ —ßÀ“√‘¡∑√—æ¬å´÷Ë߉¥â¡“‚¥¬∑“ß¡√¥° ·≈–°√≥’ºŸâ®—¥°“√¡√¥°¢Õ‚Õπ
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¯Ú ·Ààߪ√–¡«≈°ÆÀ¡“¬∑’Ë¥‘π ¡’§«“¡§≈àÕßμ—« √«¥‡√Á« ‡°‘¥ª√– ‘∑∏‘¿“æ„π°“√„Àâ∫√‘°“√ ∂Ÿ°
μâÕ߇ªìπ‰ªμ“¡∑Ë°’ ÆÀ¡“¬°”Àπ¥μ≈Õ¥®π‡ªìπ¡“μ√∞“π‡¥¬’ «°—π

Õ“»—¬Õ”π“®μ“¡§«“¡„π¡“μ√“ ÛÚ ·Ààßæ√–√“™∫—≠≠μ— √‘ –‡∫¬’ ∫∫√‘À“√√“™°“√
·ºπà ¥π‘ æ.». ÚıÛÙ ´ß÷Ë ·°â‰¢‡æ¡Ë‘ ‡μ¡‘ ‚¥¬æ√–√“™∫≠— ≠μ— √‘ –‡∫¬’ ∫∫√À‘ “√√“™°“√·ºπà ¥π‘ (©∫∫— ∑’Ë ı)
æ.». ÚıÙı ª√–°Õ∫°∫— ¢âÕ Ú (Ò) (Ù) ·≈–¢âÕ Ù °. (Òı) (°) ·Àßà °Æ°√–∑√«ß·∫àß à«π√“™°“√
°√¡∑’Ë¥‘π °√–∑√«ß¡À“¥‰∑¬ æ.». ÚıÙı ÕÕ°μ“¡§«“¡„πæ√–√“™∫—≠≠—μ‘√–‡∫’¬∫∫√‘À“√√“™
°“√·ºàπ¥‘π æ.». ÚıÛÙ Õ∏‘∫¥’°√¡∑’Ë¥‘π ®÷߇ÀÁπ ¡§«√·°â‰¢‡æË‘¡‡μ‘¡√–‡∫’¬∫¥—ß°≈à“«‚¥¬«“ß
√–‡∫’¬∫¥ß— μàÕ‰ªπ’È

¢âÕ Ò √–‡∫’¬∫π‡È’ √’¬°«“à ç√–‡∫’¬∫°√¡∑¥Ë’ ‘π «“à ¥â«¬°“√®¥∑–‡∫¬’ π ‘∑∏‡‘ °’ˬ«°—∫
Õ —ßÀ“√¡‘ ∑√æ— ¬å ´ßË÷ ‰¥â¡“‚¥¬∑“ß¡√¥° (©∫—∫∑’Ë Û) æ.». ÚııÛé

¢Õâ Ú √–‡∫¬’ ∫π’È„Àâ„™∫â ß— §∫— μÈ—ß·μ∫à ¥— πÈ’‡ªπì μâπ‰ª
¢Õâ Û „Àâ‡æ¡Ë‘ §«“¡μÕà ‰ªπ’ȇªπì (Û˘) ·≈– (Ù) ¢ÕߢâÕ Û ·Àßà √–‡∫’¬∫°√¡∑’Ë¥‘π
«“à ¥â«¬°“√®¥∑–‡∫’¬π ‘∑∏‡‘ °’¬Ë «°—∫Õ ß— À“√‘¡∑√æ— ¬´å ÷ßË ‰¥¡â “‚¥¬∑“ß¡√¥° æ.». ÚıÙ¯
ç(Û˘) Àπß—  Õ◊ °√¡∑Ë’¥‘π ∑Ë’ ¡∑ ˜Ò/« Ù¯ÙÚ ≈ß«π— ∑’Ë ÒÚ °ÿ¡¿“æ—π∏å ÚıÙÚ
(Ù) Àπ—ß ◊Õ°√¡∑’¥Ë π‘ ∑’Ë ¡∑ ıÒı/« ÙÒÒ˘ ≈ß«π— ∑Ë’ Ú¯ ∏π— «“§¡ ÚıÙ¯é
¢Õâ Ù „À⬰‡≈°‘ §«“¡„π¢Õâ ÚÚ ·≈–¢Õâ ÚÛ ·Ààß√–‡∫¬’ ∫°√¡∑Ë¥’ π‘ «à“¥«â ¬°“√
®¥∑–‡∫¬’ π ∑‘ ∏‡‘ °¬Ë’ «°∫— Õ ß— À“√¡‘ ∑√æ— ¬´å ßË÷ ‰¥¡â “‚¥¬∑“ß¡√¥° æ.».ÚıÙ¯ ·≈–„Àâ„™§â «“¡μÕà ‰ªπ·’È ∑π
ç¢âÕ ÚÚ ª√–°“»„Àâªî¥„π∑Ë’‡ªî¥‡º¬¡’°”Àπ¥ “¡ ‘∫«—π ·≈–„Àâªî¥∑ÿ°·Ààß∑’Ë
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˘ÛÒ

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(≈ß™◊ÕË ) Õπ«ÿ ≤— πå ‡¡∏’«‘∫Ÿ≈«≤ÿ ‘
(π“¬Õπ«ÿ ≤— πå ‡¡∏«’ ‘∫Ÿ≈«ÿ≤)‘
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˘Ûı

μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÒÒ μ“¡√–‡∫’¬∫œ ¢âÕ ıÚ/Ò (Ò) (∑.¥. Ò)
® ∑∫Ë’ â“π
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¡“¬◊Ëπ§”¢Õ ≥  ”π°— ß“π∑Ë’¥‘π ® ∑’Ëπ“
® ∑.Ë’ ............
μ”·Àπàß∑Ë¥’ ‘𠧔¢Õ®¥∑–‡∫¬’ π ∑‘ ∏·‘ ≈–πμ‘ °‘ √√¡ ® πÕ°‡¢μ
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√–«“ß........................................................................................................................μ”∫≈.......................................................................................................................

‡≈¢∑¥’Ë π‘ ....................................................................................................................Õ”‡¿Õ.....................................................................................................................

Àπ“â  ”√«®..............................................................................................................®—ßÀ«¥— ......................................................................................................................

‚©π¥∑¥’Ë ‘π

‡≈¢∑Ë.’ ................................................................................‡≈à¡...............................................................................Àπâ“..............................................................................

®”π«π∑Ë¥’ π‘ ....................................................................‰√.à ..................................................................................ß“π...........................................................μ“√“ß«“

Ò. ¢â“懮⓺Ÿâ¡’π“¡μàÕ‰ªπÈ’ ¡’§«“¡ª√– ß§å¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡‡°Ë’¬«°—∫Õ —ßÀ“√‘¡∑√—æ¬å∑Ë’°≈à“«¢â“ß∫ππÈ’

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ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à

(Ò) ¢“â 懮Ⓣ¡à‰¥√â ∫— ‚Õπ·∑πÀ√◊Õ‡æ◊ÕË ª√–‚¬™π·å °à∫§ÿ §≈μà“ߥ⓫

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Ú) ‚©π¥∑Ë’¥π‘ „À¡√à –«“ß.............................................................‡≈¢∑’Ë¥π‘ .............................................................Àπ“â  ”√«®......................................................

‚©π¥∑’¥Ë π‘ ‡≈¢∑’.Ë .......................................................................‡≈¡à ......................................................................Àπâ“....................................................................

®”π«π∑¥’Ë π‘ .......................................................................‰√.à ..................................................................ß“π..................................................................μ“√“ß«“

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μ—«Õ¬à“ßÀ¡“¬‡≈¢ ÒÒ μ“¡√–‡∫¬’ ∫œ ¢âÕ ıÚ/Ò (Ò) (∑.¥. ¯)

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¢“â 懮ⓢÕ√—∫√Õß«“à ∂âÕ¬§”π‡’È ªì𧫓¡ μ— ¬®å √ß‘ ∑ÿ°ª√–°“√.

}(≈ß™ËÕ◊ ).............................π...“..¬.....§.................................

(≈ß™◊ËÕ).............................π...“..ß.....ß................................. ºâŸ„À∂â âÕ¬§”
(≈ß™ÕË◊ )........................................................................
(≈ß™ËÕ◊ )........................................................................º âŸ Õ∫ «π/∫π— ∑°÷
μÕà Àπâ“.....................................................................................æπ°— ß“π‡®“â Àπ“â ∑’Ë

˘Û˜

μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÒÒ μ“¡√–‡∫¬’ ∫œ ¢Õâ ıÚ/Ò (Ò)

∫π— ∑÷°§”¬π‘ ¬Õ¡·≈–§”√∫— √ÕߢÕߺŸâ®—¥°“√¡√¥°

¢“â 懮â“........................π....“..¬.....¢.......................................º®Ÿâ ¥— °“√¡√¥°¢Õß..............π...“..¬.....°......................................
μ“¡æπ‘ —¬°√√¡©∫—∫≈ß«π— ∑Ë.’ ................‡¥◊Õπ...................................æ.». .......... ¢“â æ‡®â“¬π‘ ¬Õ¡„À‡â ®“â æπ—°ß“π∑Ë¥’ π‘ ‚Õπ∑¥’Ë π‘
à‚©π¥∑’Ë¥‘π‡≈¢∑’Ë...................................Àπâ“ ”√«®..................................μ”∫≈.......................................Õ”‡¿Õ.......................................
®—ßÀ«¥— .............................................„Àâ·°à.......π...“...¬.....§.......·...≈...–.....π...“..ß.....ß.......................................................´ß÷Ë ‡ªπì ∑“¬“∑μ“¡æπ‘ —¬°√√¡
¢Õß....................π...“...¬.....°............................√∫— ¡√¥°¢Õß........π...“...¬.....°....................................‚¥¬μ√ß ‚¥¬¢â“懮Ⓣ¡¡à §’ «“¡ª√– ß§å
„À⮥∑–‡∫¬’ π≈ß™◊ÕË º®âŸ —¥°“√¡√¥° ·≈–®—¥°“√∑√—æ¬å¡√¥°∑Ë’¥‘π·ª≈ßπμÈ’ “¡æ‘π—¬°√√¡¢Õß.....π....“..¬.....°..............................
·μÕà ¬“à ß„¥ ·≈–À“°¡’§«“¡‡ ’¬À“¬„¥Ê ‡°‘¥¢÷πÈ ¢â“懮ⓢÕ√∫— º¥‘ ™Õ∫‡Õß„π∞“π–ºâŸ®¥— °“√¡√¥°

(≈ß™ÕË◊ ).........................π...“...¬.....¢...........................º®âŸ —¥°“√¡√¥°
(≈ß™◊ËÕ)..............................................................欓π
(≈ß™ÕË◊ )..............................................................欓π
À¡“¬‡Àμÿ μÕâ ß∑”‰«Àâ ≈—ß∫π— ∑°÷ °“√ Õ∫ «π¢Õ®¥∑–‡∫¬’ π‚Õπ¡√¥° (∑.¥.¯) ‡∑“à ππ—È

˘Û¯

μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÒÒ μ“¡√–‡∫¬’ ∫œ ¢âÕ ıÚ/Ò (Ò)

(∑.¥. Úı)

ª√–°“»..... ...”..π....—°...ß..“...π...∑...’¥Ë...π‘....®..—ß...À...«...—¥...............
‡√Ë◊Õß.........................®..¥....∑...–...‡.∫....’¬...π...‚..Õ...π...¡...√...¥...°...........................

¥â«¬.........π...“..¬.....§......·...≈....–....π...“...ß.....ß........................................................‰¥â¬π◊Ë ‡√◊ÕË ß√“«¢Õ.......®...¥...∑...–...‡.∫....’¬...π...‚..Õ...π...¡...√...¥...°..................................
.....................................................Àπ—ß ◊Õ ”§≠— .................................................‡≈¢∑’Ë....................................................Àπâ“ ”√«®.................................................
À¡∑àŸ Ë’.............................μ”∫≈..............................................................Õ”‡¿Õ..............................................................®ß— À«—¥..............................................................
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¡Õ’ “≥“‡¢μ¥—ßπ’È §◊Õ :-

∑»‘ ‡ÀπÕ◊ ®¥.....................................................................................¬“«ª√–¡“≥..........................................................................
∑‘»„μâ ®¥.....................................................................................¬“«ª√–¡“≥..........................................................................
∑»‘ μ–«π— ÕÕ° ®¥.....................................................................................¬“«ª√–¡“≥..........................................................................
∑»‘ μ–«π— μ° ®¥.....................................................................................¬“«ª√–¡“≥..........................................................................
‡πÕÈ◊ ∑Ë’ª√–¡“≥.............................................................................‰√.à ...............................................................ß“π................................................................μ“√“ß«“
‚¥¬Õ“â ß«à“....º...⢟...Õ...‡..ª...πì...º....â√Ÿ ..∫—....¡...√..¥....°...μ...“..¡...æ....‘π...—¬...°...√...√..¡....¢..Õ....ß..π...“...¬.....°......¡...’π...“...¬.....¢.....‡..ª...πì....º...⟮...¥— ...°...“..√...¡...√...¥...°...μ...“...¡...æ...‘π...—¬...°...√...√...¡.....©...∫...—∫...≈....ß..«...—π...∑...’Ë.................................
.·...μ...àπ...“..¬.....¢......‰..¡...ªà...√...–... ...ß...§...å®...–...®..¥....∑...–..‡..∫...’¬....π...≈...ß...™..◊ËÕ....º...®Ÿâ...—¥...°...“..√...¡...√...¥...°...·...≈...–...®...¥— ...°...“..√...∑...√...æ—...¬...¡å....√..¥...°...∑....’Ë¥...π‘...·...ª...≈...ß...π...È’..‚..¥...¬...¬...π‘...¬....Õ...¡...„..À...®â...¥...∑...–...‡.∫....¬’...π...¡...√...¥...°...............
.≈...ß..™...ËÕ◊...π....“..¬.....§......·...≈...–...π...“...ß....ß......‡..ª...ìπ...º...⢟...Õ...√...∫— ...¡...√...¥...°...μ....“..¡...æ....‘π...¬— ...°...√...√..¡...‚..¥...¬...μ....√..ß.....‚..¥...¬...‡..ª...πì...°...“...√..¢...Õ....‚.Õ...π....¡...√..¥....°...∑...¥’Ë ...‘π...‰..¡...à¡... ’...ßË‘...ª...≈....Ÿ°... ...√..â“...ß....................................
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®÷ߢժ√–°“»„À∑â √“∫∑—«Ë °π— ∂⓺⟄¥®–§¥— §“â πª√–°“√„¥ „Àâ¬◊Ë𧔧—¥§“â πμÕà æπ—°ß“π‡®“â Àπ“â ∑’¿Ë “¬„π...... ...“..¡... ...∫‘........«—π
π∫— ·μà«—πª√–°“»π’‡È ªìπμâπ‰ª

ª√–°“» ≥ «—π∑’Ë..................‡¥◊Õπ.............................................æ.». .............................

≈ß™◊ÕË .........................................................................
/μ/”/·/À/π/ßà/................æ....π...°—...ß...“..π...‡..®...â“..À....π...“â ..∑...’Ë.....................

ª√–∑—∫μ√“ª√–®”μ”·Àπàß

˘Û˘

μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÒÒ μ“¡√–‡∫’¬∫œ ¢Õâ ıÚ/Ò (Ò)

 “√∫—≠®¥∑–‡∫¬’ π

‡πÈÕ◊ ∑Ë’¥π‘ ‡πÈÕ◊ ∑’Ë¥π‘
μ“¡ ≠— ≠“
®¥∑–‡∫’¬π ª√–‡¿∑°“√ §ß‡À≈Õ◊ √–«“ß ‡®“â æπ°— ß“π∑’Ë¥‘π
«—𠇥◊Õπ ªï ®¥∑–‡∫¬’ π ≈ß≈“¬¡Õ◊ ™ËÕ◊
ºŸâ„Àâ ≠— ≠“ ºŸâ√—∫ ≠— ≠“ ‡≈¢∑Ë¥’ π‘ ª√–∑—∫μ√“

‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß ‚©π¥∑Ë¥’ π‘ „À¡à
«“ «“

«—π∑.’Ë ......................... ‚Õπ¡√¥° 𓬠°. (ºâμŸ “¬) Ò. 𓬠§. Ò››››› › ≈ß™Õ◊Ë ..............................
‡¥◊Õπ....................... Ú. π“ß ß.
æ.». .......................

˘Ù

μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÒÚ μ“¡√–‡∫’¬∫œ ¢Õâ ıÚ/Ò (Ú) (∑.¥. Ò)
® ∑’Ë∫“â π
°√≥º’ ⮟ —¥°“√¡√¥°μ“¡æ‘π—¬°√√¡ ® ∑ ’Ë «π/‰√à
® ∑’Ëπ“
‰¡à‰¥¡â “¬πË◊ §”¢Õ ≥  ”π°— ß“π∑¥’Ë ‘π ® ∑’.Ë ............
® πÕ°‡¢μ
¡À’ πß—  ◊Õ¬‘π¬Õ¡·≈–§”√∫— √Õß ® „π‡¢μ

¢ÕߺŸâ®¥— °“√¡√¥° §”¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡

μ”·Àπßà ∑Ë¥’ π‘ ·≈–°“√ Õ∫ «π ‘∑∏‘„π∑’Ë¥π‘ ª√–‡¿∑...........‚.Õ....π...¡...√...¥...°.................

√–«“ß........................................................................................................................μ”∫≈.......................................................................................................................

‡≈¢∑’Ë¥‘π....................................................................................................................Õ”‡¿Õ.....................................................................................................................

Àπâ“ ”√«®..............................................................................................................®ß— À«¥— ......................................................................................................................

‚©π¥∑¥’Ë π‘

‡≈¢∑Ë.’ ................................................................................‡≈à¡...............................................................................Àπ“â ..............................................................................

®”π«π∑’¥Ë π‘ ....................................................................‰√à...................................................................................ß“π...........................................................μ“√“ß«“

Ò. ¢â“懮⓺⟡’π“¡μàÕ‰ªπÈ’ ¡’§«“¡ª√– ß§å¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡‡°’ˬ«°—∫Õ —ßÀ“√‘¡∑√—æ¬å∑’Ë°≈à“«¢â“ß∫ππÈ’

·≈–‰¥ªâ Ø≠‘ “≥μπ·≈«â ¢Õ„À∂â Õâ ¬§”¥«â ¬§«“¡ μ— ¬®å √ß‘ ∂“â ¢“â 懮“â „À∂â Õâ ¬§”‰¡‡à ªπì §«“¡®√ß‘ „Àâ„™∂â Õâ ¬§”π¬’È π— ¢“â 懮“â „π∑“ߧ¥Õ’ “≠“‰¥â

‡≈¢ª√–®”μ«— ª√–™“™π
Ú. ¢â“懮“â .....................π...“..¬.....°.......(..º...Ÿμâ...“...¬...).......................... ® ®®®® ®®®®® ®® ® ºŸâ...∂....◊Õ...°...√..√...¡... ...∑‘...∏...‘Ï............

Õ“¬.ÿ ................................ªï  ≠— ™“μ.‘ ..............................................∫‘¥“/¡“√¥“™◊ÕË ............................................................................................................................

® ‚ ¥ ® À¡â“¬ ® §Ÿ à ¡√ ™ËÕ◊ ...................................................................................................

Õ¬∑àŸ ’∫Ë “â π/À¡Ÿà∫“â π..........................................‡≈¢∑’.Ë .....................................μ√Õ°/´Õ¬......................................∂ππ......................................À¡Ÿà∑.’Ë ...................

μ”∫≈/·¢«ß.........................................Õ”‡¿Õ/‡¢μ.........................................®—ßÀ«—¥...........................................À¡“¬‡≈¢‚∑√»æ— ∑.å .....................................

‡≈¢ª√–®”μ—«ª√–™“™π
Û. ¢â“懮“â ....................Ò.......π...“...¬.....§......................................... ® ®®®® ®®®®® ®® ® ºŸâ....√...∫—...¡....√..¥...°.......................

Ú. π“ß ß.

Õ“¬.ÿ ................................ªï  —≠™“μ‘...............................................∫¥‘ “/¡“√¥“™◊ËÕ............................................................................................................................

® ‚ ¥ ® À¡“â ¬ ® § Ÿà ¡√ ™ÕË◊ .................................................... ≠— ™“μ.‘ .................................

Õ¬Ÿ∑à Ë’∫“â π/À¡∫àŸ â“π..........................................‡≈¢∑Ë.’ .....................................μ√Õ°/´Õ¬......................................∂ππ......................................À¡∑àŸ .’Ë ...................

μ”∫≈/·¢«ß.........................................Õ”‡¿Õ/‡¢μ.........................................®ß— À«—¥...........................................À¡“¬‡≈¢‚∑√»—æ∑.å .....................................

Ù. ¢“â 懮“â ¢Õ· ¥ß√“§“∑√æ— ¬å∑’¢Ë Õ∑”πμ‘ ‘°√√¡π’‡È ªìπ‡ßπ‘ .....................................................................∫“∑.............................. μ“ߧå

ı. ¢“â 懮ⓢÕ√—∫√Õß«à“

(Ò) ¢â“懮“â ‰¡à‰¥â√∫— ‚Õπ·∑πÀ√◊Õ‡æÕË◊ ª√–‚¬™π·å °∫à §ÿ §≈μ“à ߥ“â «

(Ú) √“§“∑√—æ¬∑å Ë’· ¥ß‰«â„π Ù. ‡ªπì √“§“∑’Ë·∑®â √ß‘
(Û) .π...“..¬.....§......·...≈...–.....π...“...ß....ß......‡..ª...ìπ...º...√Ÿâ...—∫...¡...√...¥...°...μ....“..¡...æ....π‘ ...¬— ...°...√..√...¡...¢...Õ...ß...π...“...¬.....°......‡.®...â“...¡...√..¥....°............................................................................

(Ù) ‡..®...“â..¡....√..¥....°...∂...÷ß..·...°...à°...√...√...¡...‡..¡...Õ◊Ë...«...—π...∑...Ë’..........‡..¥...Õ◊...π......................æ....»............μ....“..¡...„..∫...¡....√..≥.....∫...—μ...√...‡..≈...¢...∑...’Ë ............................................................

(ı) ¡....√..¥....°...√..“...¬...π...¡È’...π’...“...¬.....¢......‡.ª....ìπ...º...Ÿ®â...—¥...°...“..√...¡...√...¥...°...μ...“...¡...æ...π‘...—¬...°...√...√...¡.....©...∫...—∫...≈....ß..«...π—...∑...’Ë............·...μ...ºà....®âŸ ..—¥....°...“..√...¡...√...¥...°...‰..¡...¡à...’§...«...“..¡...ª....√..–... ...ß...§..å„Àâ
.®..¥...∑....–..‡..∫...’¬...π....≈...ß..™...◊ÕË....º...⮟ ..¥—....°...“..√...¡...√...¥...°...·...≈...–...®...—¥...°...“..√...∑...√...—æ...¬...¡å...√...¥...°...∑...’¥Ë....π‘ ...·...ª...≈...ß...π...È’..‚..¥...¬...¬...‘π...¬...Õ...¡....„.À....â®..¥....∑...–...‡.∫....¬’ ...π...‚..Õ...π...¡...√...¥...°...≈...ß...™...ÕË◊ . 𓬠§.

.·...≈...–..π....“..ß.....ß.....‡..ª...πì...º....Ÿ√â ..—∫....¡...√..¥....°...‚.¥....¬...μ...√...ß....μ...“...¡...À...π...—ß... ...Õ◊...§....”..¬...π‘...¬...Õ...¡....·...≈...–...§...”..√...∫—...√...Õ...ß...¢...Õ...ß..º....⮟ ..¥—....°...“..√...¡...√...¥...°.....©...∫...—∫...≈...ß...«...—π...∑...’Ë.......................

(ˆ) ‚Õπ¡√¥°∑Ë¥’ π‘ ‰¡à¡ ’ ßË‘ ª≈Ÿ° √â“ß «—π∑.’Ë ......................‡¥◊Õπ................................................æ.».................................

≈ß™ÕË◊ ................................................................º¢âŸ Õ
≈ß™ÕË◊ ...............π...“...¬.....§.......π...“...ß....ß.......................º¢Ÿâ Õ

≈ß™Ë◊Õ................................................................ºâŸ Õ∫ «π

(................................................................)

 ”À√—∫æπ°— ß“π‡®“â Àπâ“∑’Ë

Ò) √“§“ª√–‡¡π‘ ∑ÿπ∑√æ— ¬.å ........................................................................................................................∫“∑.................................................................... μ“ߧå

Ú) ‚©π¥∑’¥Ë ‘π„À¡√à –«“ß.............................................................‡≈¢∑’¥Ë ‘π.............................................................Àπ“â  ”√«®......................................................

‚©π¥∑¥’Ë π‘ ‡≈¢∑.’Ë .......................................................................‡≈¡à ......................................................................Àπâ“....................................................................

®”π«π∑¥Ë’ π‘ .......................................................................‰√.à ..................................................................ß“π..................................................................μ“√“ß«“

§ß‡À≈◊Õ..............................................................................‰√.à .................................................................ß“π..................................................................μ“√“ß«“

Û) ‰¥â®¥∑–‡∫¬’ π·≈«â ·μ«à —π∑.’Ë .........................................‡¥◊Õπ.............................................................æ.»................................................................

≈ß™◊ËÕ................................................................

(................................................................)

‡®â“æπ°— ß“π∑¥’Ë ‘π

˘ÙÒ

μ—«Õ¬“à ßÀ¡“¬‡≈¢ ÒÚ μ“¡√–‡∫¬’ ∫œ ¢âÕ ıÚ/Ú (Ú) (∑.¥. ¯)

°√≥’ºŸâ®¥— °“√¡√¥°μ“¡æπ‘ —¬°√√¡
‰¡à‰¥¡â “¬◊Ëπ§”¢Õ ≥  ”π—°ß“π∑Ë’¥‘π
¡’Àπß—  Õ◊ ¬π‘ ¬Õ¡·≈–§”√∫— √Õß
¢ÕߺŸ®â —¥°“√¡√¥°

·∫∫∫π— ∑÷°°“√ Õ∫ «π¢Õ®¥∑–‡∫’¬π‚Õπ¡√¥°
ª√–‡¿∑.........‚..Õ...π....¡...√..¥....°..................

∑’Ë¥‘π

√–«“ß................................................................................................μ”∫≈...........................................................................................................

‡≈¢∑’Ë¥π‘ ...............................................................Àπ“â  ”√«®.........................................................Õ”‡¿Õ.......................................................

}‚©π¥

π. . Û ‡≈¢∑Ë’..................................................................................®—ßÀ«—¥.........................................................................................

„∫‰μ à «π

«π— ∑’.Ë ......................‡¥◊Õπ................................................æ.».................................

‡≈¢ª√–®”μ«— ª√–™“™π
.....π...“..¬.....§......................................................................... ® ®®®® ®®®®® ®® ® ............................
¢â“懮ⓠ.....π...“..ß.....ß......................................................................... ® ®®®® ®®®®® ®® ® Õ“¬ÿ ............................ ªï

{ } { }....................................................................................... ® ®®®® ®®®®® ®® ® ............................

 —≠™“μ‘.............................................................∫‘¥“/¡“√¥“™ÕË◊ .............................................................................................................................................................

Õ¬à∑Ÿ ∫Ë’ â“π/À¡à∫Ÿ “â π..........................................‡≈¢∑Ë’......................................μ√Õ°/´Õ¬......................................∂ππ......................................À¡∑àŸ .Ë’ ...................

μ”∫≈/·¢«ß.........................................Õ”‡¿Õ/‡¢μ.........................................®—ßÀ«—¥...........................................À¡“¬‡≈¢‚∑√»—æ∑.å .....................................

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˘Ùı

μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÒÛ μ“¡√–‡∫¬’ ∫œ ¢âÕ ıÚ/Ù (Ò)

∫≠— ™’‡§√◊Õ≠“μ‘

𓬠∫. π“ß ¡.
쓬‡¡◊ËÕ μ“¬‡¡Õ◊Ë
Ò ‡¡.¬. Ùı Ú ¡.’ §. Ùˆ

𓬠°. π“ß ß. (¿√√¬“™Õ∫¥â«¬°ÆÀ¡“¬)
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(≈ß™ËÕ◊ )..............................................................................‡®“â æπ—°ß“π∑Ë¥’ ‘π

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˘Ùˆ

μ—«Õ¬à“ßÀ¡“¬‡≈¢ ÒÛ μ“¡√–‡∫’¬∫œ ¢âÕ ıÚ/Ù (Ò)

 “√∫—≠®¥∑–‡∫’¬π

®¥∑–‡∫¬’ π ª√–‡¿∑°“√ ‡πÈ◊Õ∑Ë¥’ π‘ ‡πÕÈ◊ ∑Ë¥’ π‘ √–«“ß ‡®â“æπ—°ß“π∑¥Ë’ ‘π
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‚©π¥∑’Ë¥π‘ „À¡à ª√–∑∫— μ√“
ºŸâ„Àâ ≠— ≠“ ºâ√Ÿ ∫—  —≠≠“

‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
«“ «“

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«π— ∑Ë.’ ......................... ‚Õπ¡√¥° 𓬠¢. Ò. 𓬠§. (쓬) Ò › › › › › ≈ß™◊ÕË ..............................
‡¥◊Õπ....................... ºŸâ®—¥°“√¡√¥° Ú. π“ß ß.
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μ—«Õ¬à“ßÀ¡“¬‡≈¢ ÒÙ μ“¡√–‡∫’¬∫œ ¢Õâ ıÚ/Ù (Ú) (∑.¥. Ò)
® ∑’∫Ë “â π

‚Õπ¡√¥°‚¥¬≈ß™ËÕ◊ ºâŸ®¥— °“√¡√¥° ® ∑Ë ’ «π/‰√à
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¡√¥°¢Õß∑“¬“∑∑Ë∂’ ß÷ ·°°à √√¡ ® ∑Ë.’ ............
® πÕ°‡¢μ
μ”·Àπßà ∑¥’Ë ‘𠧔¢Õ®¥∑–‡∫’¬π ‘∑∏·‘ ≈–π‘μ°‘ √√¡ ® „π‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑¥Ë’ π‘ ª√–‡¿∑...........‚..Õ...π...¡...√...¥...°.................

√–«“ß........................................................................................................................μ”∫≈.......................................................................................................................

‡≈¢∑¥’Ë π‘ ....................................................................................................................Õ”‡¿Õ.....................................................................................................................

Àπâ“ ”√«®..............................................................................................................®ß— À«¥— ......................................................................................................................

‚©π¥∑¥’Ë π‘

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®”π«π∑¥Ë’ ‘π....................................................................‰√.à ..................................................................................ß“π...........................................................μ“√“ß«“

Ò. ¢â“懮⓺⟡’π“¡μàÕ‰ªπÈ’ ¡’§«“¡ª√– ß§å¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡‡°’ˬ«°—∫Õ —ßÀ“√‘¡∑√—æ¬å∑’Ë°≈à“«¢â“ß∫ππÈ’

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‡≈¢ª√–®”μ—«ª√–™“™π
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Õ“¬ÿ.................................ªï  —≠™“μ.‘ ..............................................∫‘¥“/¡“√¥“™ÕË◊ ............................................................................................................................

® ‚ ¥ ® À¡“â ¬ ® §àŸ ¡√ ™ÕË◊ ...................................................................................................

Õ¬∑àŸ ’Ë∫â“π/À¡∫Ÿà â“π..........................................‡≈¢∑Ë’......................................μ√Õ°/´Õ¬......................................∂ππ......................................À¡àŸ∑Ë.’ ...................

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Ú. π“ß ß.

Õ“¬.ÿ ................................ªï  —≠™“μ‘...............................................∫¥‘ “/¡“√¥“™Ë◊Õ............................................................................................................................

® ‚ ¥ ® À¡“â ¬ ® § Ÿà ¡√ ™Õ◊Ë .................................................... ≠— ™“μ.‘ .................................

Õ¬àŸ∑Ë’∫“â π/À¡Ÿà∫â“π..........................................‡≈¢∑.Ë’ .....................................μ√Õ°/´Õ¬......................................∂ππ......................................À¡∑àŸ Ë’....................

μ”∫≈/·¢«ß.........................................Õ”‡¿Õ/‡¢μ.........................................®—ßÀ«¥— ...........................................À¡“¬‡≈¢‚∑√»—æ∑.å .....................................

Ù. ¢â“懮ⓢշ ¥ß√“§“∑√æ— ¬å∑Ë’¢Õ∑”πμ‘ °‘ √√¡π’ȇªìπ‡ßπ‘ .....................................................................∫“∑.............................. μ“ߧå

ı. ¢“â 懮“â ¢Õ√∫— √Õß«à“

(Ò) ¢“â 懮Ⓣ¡à‰¥â√—∫‚Õπ·∑πÀ√◊Õ‡æ◊ÕË ª√–‚¬™πå·°à∫§ÿ §≈μ“à ߥ“â «

(Ú) √“§“∑√—æ¬å∑·’Ë  ¥ß‰«â„π Ù. ‡ªìπ√“§“∑·’Ë ∑â®√‘ß

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«—π∑’Ë.......................‡¥Õ◊ π................................................æ.».................................

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Ú. π“ß ß.

≈ß™ÕË◊ .........................................................................ºŸ â Õ∫ «π

(.........................................................................)

 ”À√∫— æπ°— ß“π‡®â“Àπâ“∑’Ë

Ò) √“§“ª√–‡¡π‘ ∑πÿ ∑√—æ¬å.........................................................................................................................∫“∑.................................................................... μ“ߧå

Ú) ‚©π¥∑¥Ë’ π‘ „À¡√à –«“ß.............................................................‡≈¢∑¥Ë’ π‘ .............................................................Àπ“â  ”√«®......................................................

‚©π¥∑’¥Ë π‘ ‡≈¢∑Ë’........................................................................‡≈¡à ......................................................................Àπ“â ....................................................................

®”π«π∑¥’Ë π‘ .......................................................................‰√.à ..................................................................ß“π..................................................................μ“√“ß«“

§ß‡À≈◊Õ..............................................................................‰√à..................................................................ß“π..................................................................μ“√“ß«“

Û) ‰¥â®¥∑–‡∫¬’ π·≈â«·μ«à π— ∑Ë.’ .........................................‡¥Õ◊ π.............................................................æ.»................................................................

≈ß™◊ÕË ................................................................

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‡®“â æπ—°ß“π∑’Ë¥‘π

˘Ù¯

‚Õπ¡√¥°‚¥¬≈ß™◊ËÕ μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÒÙ μ“¡√–‡∫¬’ ∫œ ¢Õâ ıÚ/Ù (Ú) (∑.¥. ˘)
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∑Ë’∂÷ß·°à°√√¡

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∑’Ë¥‘π
√–«“ß..........................................................................................................μ”∫≈...................................................................................................................
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‚©π¥À¡“¬‡≈¢∑Ë’......................................................................................®ß— À«¥— ................................................................................................................

«—π∑.Ë’ ......................‡¥Õ◊ π................................................æ.».................................
𓬠¢. ºŸâ®—¥°“√¡√¥° 𓬠°. º∂Ÿâ Õ◊ °√√¡ ‘∑∏‘Ï
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π“ß ß. ºâŸ¢Õ√∫— ¡√¥°

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Õ¬à∑Ÿ Ë’∫â“π/À¡Ÿà∫â“π..........................................‡≈¢∑Ë’......................................μ√Õ°/´Õ¬......................................∂ππ......................................À¡Ÿ∑à .’Ë ...................

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˘Ù˘

μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÒÙ μ“¡√–‡∫¬’ ∫œ ¢Õâ ıÚ/Ù (Ú)

 “√∫—≠®¥∑–‡∫¬’ π

‡πÕ◊È ∑’¥Ë π‘ ‡πÕÈ◊ ∑Ë¥’ π‘
μ“¡ —≠≠“
®¥∑–‡∫¬’ π ª√–‡¿∑°“√ §ß‡À≈◊Õ √–«“ß ‡®“â æπ°— ß“π∑’Ë¥π‘
«—𠇥◊Õπ ªï ®¥∑–‡∫’¬π ≈ß≈“¬¡◊Õ™◊ÕË
ºâŸ„Àâ ≠— ≠“ ºŸâ√∫—  —≠≠“ ‡≈¢∑’Ë¥‘π ª√–∑—∫μ√“

‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß ‚©π¥∑’Ë¥π‘ „À¡à
«“ «“

«π— ∑Ë’.......................... ºŸ®â ¥— °“√¡√¥° 𓬠°. (ºŸμâ “¬) 𓬠¢. Ò››››› ≈ß™ËÕ◊ 𓬠 .

‡¥Õ◊ π....................... (μ“¡§” —Ëß ºâŸ®—¥°“√¡√¥°

æ.». ....................... »“≈......................... 𓬠°.

§¥’·¥ß∑’.Ë ..............

˘ı ≈ß«π— ∑.Ë’ .................)

«—π∑Ë.’ ......................... ‚Õπ¡√¥° 𓬠¢. Ò. 𓬠®. Ò››››› ≈ß™Ë◊Õ..............................
‡¥◊Õπ.......................
æ.». ....................... º®âŸ ¥— °“√¡√¥° º®Ÿâ —¥°“√¡√¥°

𓬠°. 𓬠§.

Ú. π“ß ß.

( ”‡π“)

∑Ë’ ¡∑ ıÒı.Ò/«. ÛÒÙ˜ °√¡∑’Ë¥π‘
»πŸ ¬å√“™°“√‡©≈‘¡æ√–‡°¬’ √μ‘ ¯ æ√√…“
ı ∏π— «“§¡ Úıı Õ“§“√∫’
∂ππ·®âß«—≤π– °√ÿ߇∑æœ ÒÚÒ

ÚÙ °π— ¬“¬π ÚııÛ

‡√◊ÕË ß √–‡∫¬’ ∫°√¡∑¥’Ë ‘π «“à ¥â«¬°“√®¥∑–‡∫¬’ π≈ß™Õ◊Ë §Ÿ à ¡√ ·≈–·∫àß∑√æ— ¬ å π‘ √–À«à“ߧ àŸ ¡√ 
„π∑Ë’¥π‘ ·≈–Õ —ßÀ“√∑‘ √æ— ¬Õå ¬à“ßÕ◊Ëπ æ.». ÚııÛ

‡√’¬π º«âŸ “à √“™°“√®—ßÀ«—¥∑ÿ°®ß— À«¥—
 Ëß‘ ∑Ë ’ àß¡“¥â«¬ √–‡∫¬’ ∫°√¡∑Ë’¥π‘ «à“¥â«¬°“√®¥∑–‡∫’¬π≈ß™ÕË◊ §Ÿ à ¡√ ·≈–·∫àß∑√—æ¬ å ‘π√–À«“à ß

§ àŸ ¡√ „π∑’Ë¥π‘ ·≈–Õ ß— À“√‘¡∑√—æ¬åÕ¬“à ßÕËπ◊ æ.». ÚııÛ

¥â«¬°√¡∑’Ë¥‘πæ‘®“√≥“‡ÀÁπ‡ªìπ°“√ ¡§«√¥”‡π‘π°“√ª√—∫ª√ÿß ·≈–«“ß√–‡∫’¬∫
°√¡∑Ë’¥‘π «à“¥â«¬°“√®¥∑–‡∫’¬π≈ß™◊ËÕ§àŸ ¡√ ·≈–·∫àß∑√—æ¬å ‘π√–À«à“ß§àŸ ¡√ „π∑Ë’¥‘π·≈–
Õ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕË◊π æ.». ÚııÛ ‡æË◊Õ„Àâ°“√ªØ‘∫—μ‘ß“π‡°Ë’¬«°—∫°“√®¥∑–‡∫’¬π≈ß™Ë◊Õ§Ÿà ¡√ 
·≈–·∫àß∑√—æ¬å ‘π√–À«à“ߧŸà ¡√ „π∑’Ë¥‘π·≈–Õ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ ¡’§«“¡§≈àÕßμ—« √«¥‡√Á«
‡°‘¥ª√– ‘∑∏‘¿“æ„π°“√„Àâ∫√‘°“√ ∂Ÿ°μâÕß ‡ªìπ‰ªμ“¡∑Ë’°ÆÀ¡“¬°”Àπ¥ μ≈Õ¥®π‡ªìπ¡“μ√∞“π
‡¥’¬«°—π √“¬≈–‡Õ’¬¥ª√“°Øμ“¡√–‡∫’¬∫°√¡∑Ë’¥‘π «à“¥â«¬°“√®¥∑–‡∫’¬π≈ß™Ë◊Õ§àŸ ¡√ ·≈–·∫àß
∑√æ— ¬å π‘ √–À«“à ߧ Ÿà ¡√ „π∑¥’Ë π‘ ·≈–Õ —ßÀ“√‘¡∑√æ— ¬Õå ¬à“ßÕ◊Ëπ æ.». ÚııÛ ∑Ë ’ ßà ¡“æ√âÕ¡πÈ’

®÷߇√’¬π¡“‡æ◊ËÕ‚ª√¥∑√“∫ ·≈–·®âß„Àâæπ—°ß“π‡®â“Àπâ“∑’Ë∑√“∫·≈–∂◊Õ‡ªìπ
·π«∑“ߪؑ∫—μ‘ æ√âÕ¡∑È—ßπ”√–‡∫’¬∫°√¡∑’Ë¥‘π¥—ß°≈à“«‰ªª√—∫ª√ÿ߇æË‘¡‡μ‘¡Àπ—ß ◊Õ§àŸ¡◊Õ°“√
®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡‡°Ë’¬«°—∫∑Ë’¥‘π·≈–Õ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ ‡æË◊Õ„Àâ “¡“√∂„™âÕâ“ßÕ‘ß
„Àâ∂°Ÿ μÕâ ßμ“¡√–‡∫¬’ ∫∑’ˇª≈Ë’¬π·ª≈߉ªμàÕ‰ª¥«â ¬

¢Õ· ¥ß§«“¡π∫— ∂Õ◊
(≈ß™Ë◊Õ) Õπÿ«—≤πå ‡¡∏«’ ∫‘ Ÿ≈«≤ÿ ‘

(π“¬Õπÿ«≤— πå ‡¡∏«’ ‘∫Ÿ≈«ÿ≤‘)
Õ∏‘∫¥’°√¡∑Ë’¥π‘

 ”π—°¡“μ√∞“π°“√∑–‡∫¬’ π∑Ë’¥‘π
 à«π¡“μ√∞“π°“√®¥∑–‡∫’¬π ∑‘ ∏‘·≈–πμ‘ °‘ √√¡
‚∑√. ÚÒÙÒ ı˜ˆˆ ‚∑√ “√  ÚÒÙÛ ˘ÒÚÙ

˘ıÒ

( ”‡π“)
√–‡∫¬’ ∫°√¡∑Ë’¥‘π
«à“¥â«¬°“√®¥∑–‡∫¬’ π≈ß™◊ËÕ§Ÿ à ¡√  ·≈–·∫àß∑√æ— ¬å ‘π√–À«à“ß§àŸ ¡√ 
„π∑¥Ë’ ‘π·≈–Õ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕπË◊

æ.». ÚııÛ

‚¥¬∑’ˇÀÁπ‡ªìπ°“√ ¡§«√„Àâ¡’°“√√«∫√«¡ª√—∫ª√ÿßÀ≈—°‡°≥±å·≈–«‘∏’°“√®¥∑–‡∫’¬π
≈ß™ÕË◊ § àŸ ¡√ ·≈–·∫ßà ∑√æ— ¬ å π‘ √–À«“à ߧ Ÿà ¡√ „π∑¥Ë’ π‘ ·≈–Õ ß— À“√¡‘ ∑√æ— ¬Õå ¬“à ßÕπË◊ ‡æÕ◊Ë „Àæâ π°— ß“π
‡®â“Àπâ“∑’Ë “¡“√∂ªØ‘∫—μß‘ “π¥â«¬§«“¡ –¥«°√«¥‡√Á« ¡’ª√– ‘∑∏‘¿“欑Ëߢ÷Èπ·≈–∂Ÿ°μâÕ߇ªìπ‰ªμ“¡
∑Ë°’ ÆÀ¡“¬°”Àπ¥μ≈Õ¥®π‡ªπì ¡“μ√∞“π‡¥’¬«°—π

Õ“»¬— Õ”π“®μ“¡§«“¡„π¡“μ√“ ÛÚ ·Àßà æ√–√“™∫≠— ≠μ— √‘ –‡∫¬’ ∫∫√À‘ “√√“™°“√·ºπà ¥π‘
æ.».ÚıÛÙ ´ß÷Ë ·°â‰¢‡æ¡Ë‘ ‡μ¡‘ ‚¥¬æ√–√“™∫≠— ≠μ— √‘ –‡∫¬’ ∫∫√À‘ “√√“™°“√·ºπà ¥π‘ (©∫∫— ∑’Ë ı) æ.». ÚıÙı
ª√–°Õ∫°∫— ¢Õâ Ú (Ò) (Ù) ·≈–¢Õâ Ù °. (Òı) (°) ·Àßà °Æ°√–∑√«ß·∫ßà  «à π√“™°“√°√¡∑¥’Ë π‘ °√–∑√«ß
¡À“¥‰∑¬ æ.». ÚıÙı ÕÕ°μ“¡§«“¡„πæ√–√“™∫≠— ≠μ— ‘√–‡∫¬’ ∫∫√À‘ “√√“™°“√·ºàπ¥π‘ æ.».ÚıÛÙ
Õ∏‘∫¥°’ √¡∑Ë¥’ ‘π®ß÷ «“ß√–‡∫’¬∫‰«¥â ß— μàÕ‰ªπÈ’

¢Õâ Ò √–‡∫’¬∫π’ȇ√’¬°«à“ ç√–‡∫’¬∫°√¡∑Ë’¥‘π «à“¥â«¬°“√®¥∑–‡∫’¬π≈ß™Ë◊Õ§àŸ ¡√ 
·≈–·∫ßà ∑√æ— ¬ å ‘π√–À«“à ß§àŸ ¡√ „π∑¥’Ë ‘π·≈–Õ —ßÀ“√‘¡∑√—æ¬Õå ¬à“ßÕ◊πË æ.». ÚııÛé

¢âÕ Ú √–‡∫’¬∫πÈ’„Àâ„™∫â ß— §—∫μÈß— ·μ∫à —¥π’‡È ªπì μπâ ‰ª
¢Õâ Û „À⬰‡≈‘°
(Ò) §” Ëß— °√¡∑Ë¥’ π‘ ∑’Ë ˆ/ÚÙ˘¯ ≈ß«—π∑’Ë ÚÒ æƒ…¿“§¡ ÚÙ˘¯
(Ú) Àπ—ß Õ◊ °√¡∑Ë’¥π‘ ∑’Ë ¡∑ ˜¯/« Ú˜ˆ ≈ß«π— ∑Ë’ Ú˘ 惻®‘°“¬π ÚıÚ˜
(Û) √–‡∫¬’ ∫°√¡∑¥’Ë π‘ «“à ¥«â ¬°“√®¥∑–‡∫¬’ π≈ß™Õ◊Ë § Ÿà ¡√ „πÀπß—  Õ◊ · ¥ß ∑‘ ∏„‘ π∑¥Ë’ π‘
æ.». ÚıÚ˘
(Ù) Àπ—ß ◊Õ°√¡∑’¥Ë ‘π ∑Ë’ ¡∑ ıÒı/« Ò˘Úˆ˘ ≈ß«—π∑Ë’ ÒÛ °√°Æ“§¡ Úıı
∫√√¥“√–‡∫’¬∫ ¢âÕ°”Àπ¥ À√◊Õ§” —ËßÕ◊Ëπ„¥∑Ë’°”À𥉫â·≈â«„π√–‡∫’¬∫π’È À√◊Õ´÷Ëߢ—¥
À√Õ◊ ·¬âß°—∫√–‡∫’¬∫πÈ’ „Àâ„™√â –‡∫¬’ ∫πÈ’·∑π
¢Õâ Ù „Àºâ ÕŸâ ”π«¬°“√ ”π—°¡“μ√∞“π°“√∑–‡∫’¬π∑’¥Ë ‘π‡ªìπº√Ÿâ —°…“°“√μ“¡√–‡∫’¬∫πÈ’

˘ıÚ

À¡«¥ Ò
°“√®¥∑–‡∫¬’ π≈ß™◊ÕË § Ÿà ¡√ „π∑¥Ë’ π‘ ·≈–Õ ß— À“√¡‘ ∑√—æ¬Õå ¬“à ßÕπË◊

 à«π∑Ë’ Ò
°“√¬π◊Ë §”¢Õ °“√ Õ∫ «π ·≈–ª√–‡¿∑°“√®¥∑–‡∫¬’ π≈ß™ËÕ◊ §Ÿ à ¡√ 

¢âÕ ı ‡¡◊ËÕ¡’∫ÿ§§≈„¥· ¥ß§«“¡ª√– ß§å¢Õ®¥∑–‡∫’¬π≈ß™Ë◊Õ§àŸ ¡√ „π∑Ë’¥‘π·≈–
Õ ß— À“√‘¡∑√æ— ¬åÕ¬à“ßÕË◊π μ“¡π¬— ¡“μ√“ ÒÙ˜ı ·Ààߪ√–¡«≈°ÆÀ¡“¬·æßà ·≈–æ“≥‘™¬å „À∫â §ÿ §≈
πÈ—π¬◊Ëπ§”¢Õμ“¡·∫∫ ∑.¥.Ò  ”À√—∫∑Ë’¥‘π∑’Ë¡’‚©π¥∑’Ë¥‘π À√◊Õ·∫∫ ∑.¥.Ò °  ”À√—∫∑’Ë¥‘π∑Ë’¬—߉¡à¡’
‚©π¥∑’Ë¥‘π·≈–Õ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕË◊πμàÕæπ—°ß“π‡®â“Àπâ“∑Ë’ æ√âÕ¡Àπ—ß ◊Õ· ¥ß ‘∑∏‘„π∑’Ë¥‘πÀ√◊Õ
À≈—°∞“π ”À√—∫Õ —ßÀ“√¡‘ ∑√—æ¬Õå ¬“à ßÕË◊π·≈–À≈°— ∞“πÕËπ◊ ∑ˇ’ °Ë¬’ «¢âÕß

¢Õâ ˆ „Àâæπ—°ß“π‡®â“Àπ“â ∑’Ë Õ∫ «πºŸâ¢Õμ“¡π¬— °Æ°√–∑√«ß©∫—∫∑Ë’ ˜ (æ.». ÚÙ˘˜)
ÕÕ°μ“¡§«“¡„πæ√–√“™∫≠— ≠—μ‘„Àâ„™âª√–¡«≈°ÆÀ¡“¬∑Ë¥’ ‘π æ.». ÚÙ˘˜ ·≈–°Æ°√–∑√«ß©∫∫— ∑’Ë
·°â‰¢‡æ¡Ë‘ ‡μ¡‘

¢Õâ ˜ °√≥’¡’ºâ¬Ÿ π◊Ë §”¢Õ®¥∑–‡∫¬’ π≈ß™Õ◊Ë §à Ÿ ¡√  „Àâæπ—°ß“π‡®â“Àπ“â ∑Ë’ Õ∫ «π„À≥â
§«“¡·πà™—¥«à“§Ÿà°√≥’‡ªìπ “¡’¿√‘¬“∑Ë’™Õ∫¥â«¬°ÆÀ¡“¬À√◊Õ‰¡à ·≈–∑√—æ¬å ‘π¥—ß°≈à“«‡ªìπ ‘π ¡√ 
μ“¡ª√–¡«≈°ÆÀ¡“¬·æßà ·≈–æ“≥™‘ ¬å®√‘ßÀ√◊Õ‰¡à ‡™πà μ√«® Õ∫®“°À≈—°∞“π∑–‡∫¬’ π ¡√ ·≈–
À≈°— ∞“π· ¥ß ∑‘ ∏‘°“√‰¥¡â “´ßË÷ ∑√—æ¬å ‘π¥ß— °≈“à « ‡ªπì μâπ

°√≥’∑√—æ¬å ‘π∑Ë’‰¥â¡“√–À«à“ßÕ¬àŸ°‘π©—π “¡’¿√‘¬“ ‡ªìπ∑√—æ¬å ‘π∑Ë’ “¡’·≈–¿√‘¬“‡ªìπ
‡®â“¢Õß√à«¡°—π°àÕπ°“√ ¡√  ·¡âμàÕ¡“‰¥â∑”°“√ ¡√ °—π„π¿“¬À≈—ß ∑√—æ¬å ‘π¥—ß°≈à“«¬àÕ¡μ°
‡ªìπ ‘π à«πμ—«¢Õß·μà≈–ΩÉ“¬‡∑à“Ê °—π °√≥’‡™àππ’ȇ¡◊ËÕ∑√—æ¬å ‘π‰¡à‡ªìπ ‘π ¡√ μ“¡°ÆÀ¡“¬·≈â«
¬Õà ¡‰¡àÕ¬Ÿà„πÀ≈—°‡°≥±∑å Ë’®–√∫— ®¥∑–‡∫¬’ π„πª√–‡¿∑≈ß™Ë◊Õ§Ÿà ¡√ ‰¥â

°√≥’∑Ë’°“√ ¡√  ‘Èπ ÿ¥≈ßμ“¡ª√–¡«≈°ÆÀ¡“¬·æàß·≈–æ“≥‘™¬å·≈⫉¡à«à“®–‡ªìπ
°√≥’À¬à“ À√◊Õ∂÷ß·°à§«“¡μ“¬ À“°ºŸâ¢Õª√– ß§å®–π”∑√—æ¬å ‘π ‘π ¡√ ∑Ë’§Ÿà ¡√ ΩÉ“¬ÀπË÷ßΩÉ“¬
„¥¡’™◊ËÕ‡ªìπ‡®â“¢Õß·μà‡æ’¬ßΩÉ“¬‡¥’¬«¡“‡æ◊ËÕ¢Õ„Àâ≈ß™Ë◊Õ§àŸ ¡√ Õ’°ΩÉ“¬Àπ÷Ëߥ⫬¿“¬À≈—ß°“√ ¡√ 
 π‘È  ¥ÿ ·≈«â °√≥‡’ ™πà π‡È’ ¡Õ◊Ë °“√ ¡√  π‘È  ¥ÿ ≈ß·≈«â ¬Õà ¡‰¡Õà “®√∫— ®¥∑–‡∫¬’ π„πª√–‡¿∑≈ß™Õ◊Ë § Ÿà ¡√ ‰¥â
·μà‡ªìπ°√≥’∑Ë’μâÕßæ‘®“√≥“¥”‡π‘π°“√√—∫®¥∑–‡∫’¬π„πª√–‡¿∑·∫àß∑√—æ¬å ‘π√–À«à“ß§àŸ ¡√  μ“¡
π—¬¢Õâ Òı, Òˆ ·≈–¢Õâ Ò˜ ·≈â«·μà°√≥’

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‡πÈÕ◊ ∑¥’Ë ‘π ‡πÕ◊È ∑Ë¥’ ‘π
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ºâŸ√∫—  ≠— ≠“ ‡≈¢∑’¥Ë π‘ ª√–∑—∫μ√“

‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß ‚©π¥∑’Ë¥‘π„À¡à ≈ß™Õ◊Ë π“¬  .
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μ—«Õ¬“à ßÀ¡“¬‡≈¢ Ú (∑.¥. Ò)
® ∑∫Ë’ â“π

® ∑’ Ë «π/‰√à

® ∑’Ëπ“

μ”·Àπßà ∑’Ë¥‘𠧔¢Õ®¥∑–‡∫’¬π ∑‘ ∏‘·≈–π‘μ°‘ √√¡ ® ∑Ë’.............
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® „π‡¢μ

√–«“ß........................................................................................................................μ”∫≈.......................................................................................................................

‡≈¢∑’¥Ë ‘π....................................................................................................................Õ”‡¿Õ.....................................................................................................................

Àπâ“ ”√«®..............................................................................................................®—ßÀ«¥— ......................................................................................................................

‚©π¥∑Ë¥’ ‘π

‡≈¢∑’Ë.................................................................................‡≈¡à ...............................................................................Àπ“â ..............................................................................

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Õ¬àŸ∑’Ë∫“â π/À¡∫Ÿà â“π..........................................‡≈¢∑’Ë......................................μ√Õ°/´Õ¬......................................∂ππ......................................À¡∑àŸ .Ë’ ...................

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Ú. 𓬠°.

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® ‚ ¥ ® À¡“â ¬ ® § àŸ ¡√ ™ÕË◊ .................................................... ≠— ™“μ.‘ .................................

Õ¬Ÿà∑Ë∫’ â“π/À¡àŸ∫â“π..........................................‡≈¢∑’Ë......................................μ√Õ°/´Õ¬......................................∂ππ......................................À¡Ÿà∑Ë.’ ...................

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Ù. ¢â“懮ⓢշ ¥ß√“§“∑√—æ¬∑å Ë¢’ Õ∑”πμ‘ °‘ √√¡π’‡È ªπì ‡ß‘π.....................................................................∫“∑.............................. μ“ߧå

ı. ¢â“懮ⓢÕ√∫— √Õß«“à

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(Ú) √“§“∑√æ— ¬å∑Ë·’  ¥ß‰«â„π Ù. ‡ªπì √“§“∑·Ë’ ∑â®√ß‘

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®”π«π∑¥Ë’ π‘ .......................................................................‰√.à ..................................................................ß“π..................................................................μ“√“ß«“

§ß‡À≈◊Õ..............................................................................‰√.à .................................................................ß“π..................................................................μ“√“ß«“

Û) ‰¥â®¥∑–‡∫¬’ π·≈â«·μ«à —π∑.’Ë .........................................‡¥Õ◊ π.............................................................æ.»................................................................

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‡πÈÕ◊ ∑Ë¥’ ‘π ‡πÕÈ◊ ∑Ë¥’ ‘π
μ“¡ ≠— ≠“
®¥∑–‡∫¬’ π ª√–‡¿∑°“√ §ß‡À≈◊Õ √–«“ß ‡®â“æπ°— ß“π∑’¥Ë ‘π
«π— ‡¥◊Õπ ªï ®¥∑–‡∫¬’ π ºŸâ„Àâ —≠≠“ ≈ß≈“¬¡◊Õ™◊ËÕ
ºŸâ√∫—  ≠— ≠“ ‡≈¢∑¥Ë’ ‘π ª√–∑∫— μ√“

‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß ‚©π¥∑¥’Ë π‘ „À¡à
«“ «“

«π— ∑Ë.’ ......................... ¢“¬ 𓬠®. Ò. 𓬠°. ı››››› ≈ß™ÕË◊ 𓬠 .
‡¥Õ◊ π....................... Ú. 𓬠§.
æ.». .......................

˘ˆ˜ «π— ∑.Ë’ ......................... ≈ß™Ë◊էࠟ ¡√  Ò. 𓬠°. Ò. π“ß ¢. ı››››› ≈ß™ÕË◊ ..............................
‡¥◊Õπ....................... ‡©æ“– à«π Ú. 𓬠§. Ú. 𓬠°. 𓬠°. „Àπâ “ß ¢. ≈ß™Ë◊Õ§Ÿà ¡√ ‡©æ“– à«π
æ.». ....................... Û. 𓬠§. ¢Õßμπ‡∑“à πÈπ—  «à π¢Õß∫§ÿ §≈Õπ◊Ë §ß‡¥¡‘

μ—«Õ¬“à ßÀ¡“¬‡≈¢ Û (∑.¥. Ò)
® ∑Ë∫’ “â π
(°√≥’¡™’ ËÕ◊ §à Ÿ ¡√ ∂Õ◊ °√√¡ ∑‘ ∏‘ΩÏ “É ¬‡¥¬’ «) ® ∑Ë ’ «π/‰√à
® ∑Ë’π“
μ”·Àπßà ∑Ë’¥π‘ §”¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–πμ‘ ‘°√√¡ ® ∑’Ë.............
·≈–°“√ Õ∫ «π ‘∑∏„‘ π∑¥’Ë ‘π ª√–‡¿∑...·...∫...àß...∑...√...æ—...¬...å ...π‘...√...–...À...«...“à ..ß...§...Ÿà ...¡...√... . ® πÕ°‡¢μ
® „π‡¢μ

√–«“ß........................................................................................................................μ”∫≈.......................................................................................................................

‡≈¢∑¥’Ë ‘π....................................................................................................................Õ”‡¿Õ.....................................................................................................................

Àπ“â  ”√«®..............................................................................................................®—ßÀ«—¥......................................................................................................................

‚©π¥∑Ë’¥‘π

‡≈¢∑.Ë’ ................................................................................‡≈¡à ...............................................................................Àπâ“..............................................................................

®”π«π∑¥Ë’ π‘ ....................................................................‰√à...................................................................................ß“π...........................................................μ“√“ß«“

Ò. ¢â“懮⓺Ÿâ¡’π“¡μàÕ‰ªπ’È ¡’§«“¡ª√– ß§å¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡‡°’ˬ«°—∫Õ —ßÀ“√‘¡∑√—æ¬å∑’Ë°≈à“«¢â“ß∫ππ’È

·≈–‰¥ªâ Ø≠‘ “≥μπ·≈«â ¢Õ„À∂â Õâ ¬§”¥«â ¬§«“¡ μ— ¬®å √ß‘ ∂“â ¢“â 懮“â „À∂â Õâ ¬§”‰¡‡à ªπì §«“¡®√ß‘ „Àâ„™∂â Õâ ¬§”π¬È’ π— ¢“â 懮“â „π∑“ߧ¥Õ’ “≠“‰¥â

‡≈¢ª√–®”μ«— ª√–™“™π
Ú. ¢“â 懮â“......................π...“...¬.....°............................................. ® ®®®® ®®®®® ®® ® º.⟠..∂....◊Õ...°...√..√...¡... ...∑‘...∏...Ï‘............

Õ“¬ÿ.................................ªï  —≠™“μ‘...............................................∫‘¥“/¡“√¥“™Ë◊Õ............................................................................................................................

® ‚ ¥ ® À¡â“¬ ® §àŸ ¡√ ™◊ÕË ...................................................................................................

Õ¬∑Ÿà Ë∫’ “â π/À¡Ÿ∫à â“π..........................................‡≈¢∑Ë.’ .....................................μ√Õ°/´Õ¬......................................∂ππ......................................À¡Ÿ∑à .Ë’ ...................

μ”∫≈/·¢«ß.........................................Õ”‡¿Õ/‡¢μ.........................................®—ßÀ«—¥...........................................À¡“¬‡≈¢‚∑√»æ— ∑.å .....................................

‡≈¢ª√–®”μ«— ª√–™“™π
Û. ¢â“懮â“......................π...“..ß.....¢.............................................. ® ®®®® ®®®®® ®® ® ºŸ.â ...√...—∫...‚..Õ...π...........................

Õ“¬ÿ.................................ªï  ≠— ™“μ‘...............................................∫¥‘ “/¡“√¥“™ÕË◊ ............................................................................................................................

® ‚ ¥ ® À¡â“¬ ® § Ÿà ¡√ ™Õ◊Ë .................................................... ≠— ™“μ.‘ .................................

Õ¬∑àŸ Ë∫’ â“π/À¡∫àŸ “â π..........................................‡≈¢∑’Ë......................................μ√Õ°/´Õ¬......................................∂ππ......................................À¡∑Ÿà ’.Ë ...................

μ”∫≈/·¢«ß.........................................Õ”‡¿Õ/‡¢μ.........................................®—ßÀ«—¥...........................................À¡“¬‡≈¢‚∑√»æ— ∑.å .....................................

Ù. ¢“â 懮ⓢշ ¥ß√“§“∑√—æ¬å∑’¢Ë Õ∑”π‘μ‘°√√¡π’‡È ªìπ‡ß‘π.....................................................................∫“∑.............................. μ“ߧå

ı. ¢â“懮ⓢÕ√—∫√Õß«“à

(Ò) ¢“â 懮“â ‰¡à‰¥â√∫— ‚Õπ·∑πÀ√◊Õ‡æÕË◊ ª√–‚¬™πå·°∫à §ÿ §≈μ“à ߥ⓫

(Ú) √“§“∑√—æ¬å∑’·Ë  ¥ß‰«â„π Ù. ‡ªìπ√“§“∑·’Ë ∑â®√‘ß
(Û) ‡..ª...ìπ...∑....√..—æ....¬... å...π‘...∑...Ë’.‰.¥....¡â ...“..√...–...À...«..“à...ß... ...¡...√... .....·...≈...–...‡.ª....πì ... ...‘π... ...¡...√... .....‰..¥...¡â...“..‚..¥....¬.........................................................‡.¡...Õ◊Ë....«..—π...∑....’.Ë .............‡.¥...Õ◊....π.....................................æ...»................
(Ù) ®...¥...∑....–..‡..∫...’¬...π... ....¡...√.. ....μ...“..¡...∑....–..‡..∫...¬’...π... ....¡...√.. ....‡.≈...¢...∑...’.Ë ............‡..¡...◊ËÕ...«...—π...∑...’Ë.........‡..¥...Õ◊....π....................æ....»............∑...—Èß... ...Õ...ß...Ω...“É...¬...À...¬...“à..¢...“...¥...®...“..°...°...—π.

/(ı//) μ....“..¡..............‡..≈...¢...∑...’Ë............≈...ß...«...π— ...∑...Ë’.......‡..¥...◊Õ...π.................æ....».............μ...°...≈...ß...·...∫...ßà... ...π‘ ... ...¡...√... ...‚..¥...¬...‚..Õ...π...∑...Ë¥’...‘π....·...ª...≈...ß...π...È’..‰..¡...à¡...’ ...‘ßË...ª...≈...Ÿ°... ...√...“â..ß.

„..À...·â...°...à..π...“...ß.....¢.....‡..ª...ìπ....º...∂⟠...Õ◊ ...°...√...√..¡... ...∑‘....∏...Ï‘‡.æ....¬’ ...ß..§....π...‡..¥...¬’...«................................................................................................................................

«—π∑Ë.’ ......................‡¥Õ◊ π................................................æ.».................................
≈ß™◊ËÕ.............................π...“..¬.....°..................................º¢Ÿâ Õ

≈ß™ËÕ◊ .............................π...“..ß.....¢..................................º¢âŸ Õ

≈ß™Ë◊Õ.........................................................................º âŸ Õ∫ «π

(.........................................................................)

 ”À√—∫æπ—°ß“π‡®“â Àπâ“∑’Ë

Ò) √“§“ª√–‡¡‘π∑ÿπ∑√—æ¬å.........................................................................................................................∫“∑.................................................................... μ“ߧå

Ú) ‚©π¥∑¥’Ë ‘π„À¡√à –«“ß.............................................................‡≈¢∑¥’Ë π‘ .............................................................Àπâ“ ”√«®......................................................

‚©π¥∑’¥Ë π‘ ‡≈¢∑’.Ë .......................................................................‡≈à¡......................................................................Àπâ“....................................................................

®”π«π∑¥’Ë π‘ .......................................................................‰√.à ..................................................................ß“π..................................................................μ“√“ß«“

§ß‡À≈◊Õ..............................................................................‰√.à .................................................................ß“π..................................................................μ“√“ß«“

Û) ‰¥®â ¥∑–‡∫¬’ π·≈â«·μà«π— ∑Ë.’ .........................................‡¥Õ◊ π.............................................................æ.»................................................................

≈ß™Õ◊Ë ................................................................

(................................................................)

‡®“â æπ°— ß“π∑¥Ë’ ‘π

˘ˆ¯

(°√≥’¡’™Ë◊էࠟ ¡√ ∂Õ◊ °√√¡ ‘∑∏‘ΩÏ É“¬‡¥¬’ «) μ«— Õ¬à“ßÀ¡“¬‡≈¢ Û

(∑.¥. Òˆ)

∫π— ∑°÷ ¢Õâ μ°≈ß ·∫àß∑√æ— ¬ å π‘ √–À«à“ß§àŸ ¡√ 

∑Ë’¥‘π
√–«“ß..........................................................................................................μ”∫≈...................................................................................................................
‡≈¢∑Ë’¥‘π.............................................................Àπâ“ ”√«®....................................................................Õ”‡¿Õ................................................................
‚©π¥À¡“¬‡≈¢∑’.Ë .....................................................................................®ß— À«—¥................................................................................................................
∑’Ë«à“°“√......................................................................................................
«—π∑’Ë.......................‡¥◊Õπ................................................æ.». ................................
‡≈¢ª√–®”μ«— ª√–™“™π
¢â“懮â“....................π...“...¬.....°..................º...Ÿâ∂...Õ◊...°...√...√..¡.... ...‘∑...∏...‘Ï .............................................................. ® ®®®® ®®®®® ®® ®
....................π...“..ß.....¢..................º...â√Ÿ...∫—...‚..Õ...π............................................................................... ® ®®®® ®®®®® ®® ®

Õ“¬.ÿ ..................ªï ‡™ÕÈ◊ ™“μ‘....................................... —≠™“μ‘..........................................∫‘¥“/¡“√¥“™ËÕ◊ .......................................................................................
Õ¬Ÿ∑à ’Ë∫â“π/À¡∫àŸ â“π..........................................‡≈¢∑.Ë’ .....................................μ√Õ°/´Õ¬......................................∂ππ......................................À¡∑Ÿà ’Ë....................
μ”∫≈/·¢«ß.........................................Õ”‡¿Õ/‡¢μ.........................................®ß— À«—¥...........................................À¡“¬‡≈¢‚∑√»æ— ∑.å .....................................
¢//Õ/ª/Ø/‘≠//“/≥/μ//π/·/≈/–/„/À/â∂/Õâ /¬/§/”/μ//àÕ....‰..¥...∑â...”..∫....π— ...∑...°÷...¢...âÕ...μ...°...≈...ß...μ...àÕ...‡..®...“â..æ....π...°—...ß...“..π...∑....’¥Ë ...π‘ .....................................................................................................................
¥//â«/¬/§/«/“/¡/ /—μ/¬//å®/√/ß‘ ¥ß— μàÕ‰ªπÈ’ :-
...................¢...âÕ.....Ò......∑....’¥Ë ...π‘...·...ª...≈...ß...‡..§...√...ËÕ◊...ß...À...¡...“..¬...¥....—ß..°...≈....“à ..«...¢...â“..ß...μ...âπ...¡...’™...Ë◊Õ...¢...“â...æ...‡..®...â“....π...“...¬.....°......‡.ª....ìπ...º...âŸ∂...◊Õ...°...√...√..¡.... ...∑‘...∏...‘Ï..‡..ª...ìπ...∑...√...æ—...¬...å ...‘π...∑....Ë’‰..¥...¡â...“...„.π....√..–...À...«...“à..ß... ...¡...√.. 
.·...≈...–..‡..ª...πì.... ...‘π... ...¡...√... .....‰..¥...¡â...“..‚..¥...¬.............................‡.¡...◊ÕË....«..—π...∑....Ë’ ............‡.¥...Õ◊....π............................æ....»............¢...“â...æ...‡..®...“â ..∑...ß—È... ...Õ...ß...®...¥...∑...–...‡..∫...¬’...π... ...¡...√... ...μ...“...¡...∑...–...‡..∫...’¬...π... ...¡...√... ..
.‡.≈...¢...∑....’Ë .....................‡..¡...◊ËÕ...«...—π...∑...Ë’............‡..¥...◊Õ....π............................æ....»............≥...... ....”..π...°—...ß...“..π....‡.¢...μ........................................................................................................................
...................¢...âÕ.....Ú......¢...â“...æ...‡..®...â“..∑...ß—È... ...Õ...ß...Ω...É“...¬.....À...¬...à“..¢...“...¥...®...“..°...°...—π....μ...“..¡.........................‡..≈...¢...∑...Ë’.............≈...ß...«...π— ...∑...Ë’ ............‡..¥...◊Õ...π............................æ.....»............μ...°...≈...ß...·...∫...ßà.......
. ...‘π... ...¡...√... ...‚..¥...¬...‚..Õ...π...∑...¥Ë’...π‘...·...ª....≈...ß...π...’È..‰.¡....¡à ... ’...Ëß‘...ª...≈...Ÿ°... ...√...“â..ß.....„..À...â·...°...à..π...“...ß....¢......‡..ª...ìπ...º...∂Ÿâ...Õ◊....°...√..√...¡... ...‘∑...∏...‘χ..æ...¬’...ß...§...π....‡.¥...’.¬...«...........................................................................
...................∫...π—...∑...°÷...¢...âÕ...μ....°...≈...ß...π...È’∑...”..‰..«...âÀ...π...Ë÷ß...©...∫...—∫.....‡..°...Á∫...‰..«...â..≥...... ...”...π...°—...ß...“..π...∑...’Ë¥....‘π.....¢...“â ..œ.....∑...—Èß... ...Õ...ß...Ω...“É..¬...‰..¥...μâ....√..«...®...¥...Ÿ∫...—π...∑...°÷...¢...Õâ....μ...°...≈...ß...·...≈...–...‡.¢...â“...„.®...¢...âÕ...§....«..“...¡...........
.μ...≈...Õ...¥...·...≈...«â.....®...÷ß..≈...ß...≈...“...¬...¡...Õ◊...™...Õ◊Ë...À...√...◊Õ...≈...ß...≈...“...¬...æ...‘¡...æ....πå ...‘«È..¡....Õ◊ ...‰..«..‡â..ª...πì...À...≈....°— ...∞..“...π...μ...Õà...À....π...â“..æ...¬....“..π...·...≈...–...‡..®...â“..æ...π....—°...ß..“...π...∑...’¥Ë...π‘...................................................................
..........................................................................................................................................................................................................................................................................
................................................................................................................................................≈...ß...™...◊ËÕ.................................π....“..¬.....°..................................º...∂âŸ...◊Õ...°...√...√..¡... ....‘∑...∏...‘Ï ......
................................................................................................................................................≈...ß...™...◊ËÕ.................................π....“..ß.....¢..................................º...√⟠..—∫....‚.Õ....π......................
................................................................................................................................................≈...ß...™...Ë◊Õ.............................................................................æ...¬...“..π............................
................................................................................................................................................≈...ß...™...Ë◊Õ.............................................................................æ...¬...“..π............................
..................∫...π—...∑...°÷....¢..âÕ....μ...°...≈...ß...π...’ȉ..¥...â∑...”...μ...àÕ...À...π...“â...............................................................................................................................................................................................
................................................................................................................................................≈...ß...™...Ë◊Õ.............................................................................‡.®...â“...æ...π...—°...ß...“..π....∑...Ë¥’ ...‘π.....
..................................................................................................................................................................ª...√...–..∑....—∫...μ...√...“..μ...”...·...À...π...àß...‡..ª...ìπ... ...”...§...—≠..............................................
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˘ˆ˘

μ—«Õ¬“à ßÀ¡“¬‡≈¢ Û

(°√≥¡’ ’™ÕË◊ § àŸ ¡√ ∂Õ◊ °√√¡ ‘∑∏Ω‘Ï “É ¬‡¥¬’ «)

 “√∫≠— ®¥∑–‡∫’¬π

‡πÈÕ◊ ∑¥Ë’ ‘π ‡πÕÈ◊ ∑Ë’¥π‘
μ“¡ —≠≠“
®¥∑–‡∫’¬π ª√–‡¿∑°“√ §ß‡À≈◊Õ √–«“ß ‡®“â æπ—°ß“π∑¥’Ë ‘π
«π— ‡¥◊Õπ ªï ®¥∑–‡∫’¬π ºŸâ„Àâ ≠— ≠“ ≈ß≈“¬¡Õ◊ ™ËÕ◊
ºŸâ√∫—  ≠— ≠“ ‡≈¢∑’Ë¥‘π ª√–∑∫— μ√“

‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß ‚©π¥∑¥Ë’ ‘π„À¡à
«“ «“

«—π∑’.Ë ......................... ¢“¬ 𓬠®. 𓬠°. ı › › › › › ≈ß™ÕË◊ 𓬠 .
‡¥Õ◊ π.......................
æ.». .......................

˘˜ «π— ∑.Ë’ ......................... ·∫ßà ∑√—æ¬ å ‘π 𓬠°. π“ß ¢. ı››››› ≈ß™Õ◊Ë ..............................
‡¥Õ◊ π....................... √–À«“à ߧࠟ ¡√ 
æ.». .......................

μ—«Õ¬“à ßÀ¡“¬‡≈¢ Ù (∑.¥. Ò)
® ∑∫’Ë â“π
°√≥¡’ ™’ ËÕ◊ §Ÿ à ¡√ ∂Õ◊ °√√¡ ‘∑∏Ï‘∑ß—È Ú ΩÉ“¬ ® ∑’Ë «π/‰√à

® ∑’Ëπ“

§”¢Õ®¥∑–‡∫¬’ π ∑‘ ∏·‘ ≈–πμ‘ °‘ √√¡ ® ∑’Ë.............

® πÕ°‡¢μ

μ”·Àπàß∑Ë’¥‘π ·≈–°“√ Õ∫ «π ‘∑∏‘„π∑¥Ë’ π‘ ª√–‡¿∑...·...∫...ßà...∑...√...æ—...¬...å ...‘π...√...–...À...«...à“..ß...§...Ÿ à...¡...√... . ® „π‡¢μ

√–«“ß........................................................................................................................μ”∫≈.......................................................................................................................

‡≈¢∑Ë¥’ π‘ ....................................................................................................................Õ”‡¿Õ.....................................................................................................................

Àπâ“ ”√«®..............................................................................................................®ß— À«—¥......................................................................................................................

‚©π¥∑’Ë¥‘π

‡≈¢∑’Ë.................................................................................‡≈à¡...............................................................................Àπâ“..............................................................................

®”π«π∑¥’Ë π‘ ....................................................................‰√.à ..................................................................................ß“π...........................................................μ“√“ß«“

Ò. ¢â“懮⓺⟡’π“¡μàÕ‰ªπÈ’ ¡’§«“¡ª√– ß§å¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡‡°Ë’¬«°—∫Õ —ßÀ“√‘¡∑√—æ¬å∑Ë’°≈à“«¢â“ß∫ππÈ’

·≈–‰¥ªâ Ø≠‘ “≥μπ·≈«â ¢Õ„À∂â Õâ ¬§”¥«â ¬§«“¡ μ— ¬®å √ß‘ ∂“â ¢“â 懮“â „À∂â Õâ ¬§”‰¡‡à ªπì §«“¡®√ß‘ „Àâ„™∂â Õâ ¬§”π¬È’ π— ¢“â 懮“â „π∑“ߧ¥Õ’ “≠“‰¥â

‡≈¢ª√–®”μ«— ª√–™“™π
Ú. ¢â“懮â“................Ò.......π...“...¬.....°............................................. ® ®®®® ®®®®® ®® ® º.Ÿâ ...∂...◊Õ...°...√...√..¡... ...∑‘....∏...‘Ï ...........

Ú. π“ß ¢.

Õ“¬.ÿ ................................ªï  —≠™“μ‘...............................................∫¥‘ “/¡“√¥“™◊ËÕ............................................................................................................................

® ‚ ¥ ® À¡â“¬ ® §Ÿ à ¡√ ™Ë◊Õ...................................................................................................

Õ¬∑àŸ Ë∫’ â“π/À¡∫Ÿà “â π..........................................‡≈¢∑Ë’......................................μ√Õ°/´Õ¬......................................∂ππ......................................À¡àŸ∑.’Ë ...................

μ”∫≈/·¢«ß.........................................Õ”‡¿Õ/‡¢μ.........................................®ß— À«¥— ...........................................À¡“¬‡≈¢‚∑√»—æ∑.å .....................................

‡≈¢ª√–®”μ«— ª√–™“™π
Û. ¢â“懮â“......................π...“...ß.....¢............................................. ® ®®®® ®®®®® ®® ® ºâ.Ÿ ....√...∫—...‚..Õ...π..........................

Õ“¬ÿ.................................ªï  —≠™“μ‘...............................................∫‘¥“/¡“√¥“™Õ◊Ë ............................................................................................................................

® ‚ ¥ ® À¡“â ¬ ® § àŸ ¡√ ™Õ◊Ë .................................................... ≠— ™“μ.‘ .................................

Õ¬à∑Ÿ ’Ë∫â“π/À¡Ÿà∫“â π..........................................‡≈¢∑’.Ë .....................................μ√Õ°/´Õ¬......................................∂ππ......................................À¡à∑Ÿ .’Ë ...................

μ”∫≈/·¢«ß.........................................Õ”‡¿Õ/‡¢μ.........................................®—ßÀ«—¥...........................................À¡“¬‡≈¢‚∑√»—æ∑.å .....................................

Ù. ¢“â 懮“â ¢Õ· ¥ß√“§“∑√—æ¬å∑¢Ë’ Õ∑”πμ‘ °‘ √√¡π‡’È ªπì ‡ßπ‘ .....................................................................∫“∑.............................. μ“ߧå

ı. ¢â“懮ⓢÕ√∫— √Õß«à“

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 ”À√∫— æπ°— ß“π‡®â“Àπâ“∑Ë’

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‡®â“æπ°— ß“π∑¥’Ë π‘

˘˜Ò

μ—«Õ¬“à ßÀ¡“¬‡≈¢ Ù

°√≥¡’ ’™◊Ëէࠟ ¡√ ∂Õ◊ °√√¡ ∑‘ ∏‘Ï Ú ΩÉ“¬

(∑.¥. Òˆ)

∫π— ∑°÷ ¢âÕμ°≈ß ·∫àß∑√—æ¬å ‘π√–À«à“ߧŸà ¡√ 

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˘˜Ú

μ«— Õ¬à“ßÀ¡“¬‡≈¢ Ù

°√≥’¡™’ Õ◊Ë §Ÿà ¡√ ∂Õ◊ °√√¡ ∑‘ ∏∑Ï‘ ßÈ— Ú Ω“É ¬  “√∫≠— ®¥∑–‡∫’¬π

‡π◊ÈÕ∑¥Ë’ ‘π ‡πÕÈ◊ ∑Ë¥’ π‘
μ“¡ —≠≠“
®¥∑–‡∫’¬π ª√–‡¿∑°“√ §ß‡À≈◊Õ √–«“ß ‡®“â æπ°— ß“π∑¥Ë’ π‘
«π— ‡¥◊Õπ ªï ®¥∑–‡∫¬’ π ºâŸ„À â —≠≠“ ≈ß≈“¬¡Õ◊ ™◊ÕË
ºŸâ√—∫ ≠— ≠“ ‡≈¢∑’Ë¥π‘ ª√–∑∫— μ√“

‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß ‚©π¥∑Ë¥’ ‘π„À¡à
«“ «“

«—π∑Ë.’ ......................... ¢“¬ 𓬠®. Ò. 𓬠°. ı››››› ≈ß™ËÕ◊ 𓬠 .
‡¥◊Õπ....................... Ú. π“ß ¢.
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˘˜Û «π— ∑’Ë.......................... ·∫ßà ∑√æ— ¬å ‘π Ò. 𓬠°. π“ß ¢. ı››››› ≈ß™◊ËÕ..............................
‡¥Õ◊ π....................... √–À«“à ߧ Ÿà ¡√  Ú. π“ß ¢.
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μ«— Õ¬à“ßÀ¡“¬‡≈¢ ı (∑.¥. Ò)
® ∑Ë∫’ “â π
°√≥’¬—ß¡’ «à π¢ÕߧŸ à ¡√ Õ’°ΩÉ“¬‡À≈◊ÕÕ¬àŸ ® ∑Ë ’ «π/‰√à
® ∑’Ëπ“
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® „π‡¢μ

√–«“ß........................................................................................................................μ”∫≈.......................................................................................................................

‡≈¢∑¥Ë’ ‘π....................................................................................................................Õ”‡¿Õ.....................................................................................................................

Àπâ“ ”√«®..............................................................................................................®ß— À«¥— ......................................................................................................................

‚©π¥∑¥Ë’ ‘π

‡≈¢∑’Ë.................................................................................‡≈¡à ...............................................................................Àπ“â ..............................................................................

®”π«π∑Ë’¥π‘ .................................ı...................................‰√à.......................................›............................................ß“π..............................›.............................μ“√“ß«“

Ò. ¢â“懮⓺⟡’π“¡μàÕ‰ªπ’È ¡’§«“¡ª√– ß§å¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡‡°Ë’¬«°—∫Õ —ßÀ“√‘¡∑√—æ¬å∑Ë’°≈à“«¢â“ß∫ππÈ’

·≈–‰¥ªâ Ø≠‘ “≥μπ·≈«â ¢Õ„À∂â Õâ ¬§”¥«â ¬§«“¡ μ— ¬®å √ß‘ ∂“â ¢“â 懮“â „À∂â Õâ ¬§”‰¡‡à ªπì §«“¡®√ß‘ „Àâ„™∂â Õâ ¬§”π¬È’ π— ¢“â 懮“â „π∑“ߧ¥Õ’ “≠“‰¥â

‡≈¢ª√–®”μ—«ª√–™“™π

Ú. ¢â“懮“â ........................Ò.......π....“..¬.....°..................................... ® ®®®® ®®®®® ®® ® ºâŸ...∂....◊Õ...°...√..√...¡... ...‘∑...∏...Ï‘............
Ú. π“ß ¢.

Õ“¬ÿ.................................ªï  —≠™“μ‘...............................................∫‘¥“/¡“√¥“™Ë◊Õ............................................................................................................................

® ‚ ¥ ® À¡“â ¬ ® §àŸ ¡√ ™Ë◊Õ...................................................................................................

Õ¬Ÿà∑’Ë∫“â π/À¡Ÿà∫“â π..........................................‡≈¢∑’Ë......................................μ√Õ°/´Õ¬......................................∂ππ......................................À¡Ÿ∑à ’Ë....................

μ”∫≈/·¢«ß.........................................Õ”‡¿Õ/‡¢μ.........................................®ß— À«—¥...........................................À¡“¬‡≈¢‚∑√»æ— ∑.å .....................................

‡≈¢ª√–®”μ«— ª√–™“™π
Û. ¢â“懮â“..........................Ò.......π...“..ß.....¢.................................... ® ®®®® ®®®®® ®® ® ºŸ.â ....√...∫— ...‚..Õ...π..........................

Ú. 𓬠°.

Õ“¬ÿ.................................ªï  —≠™“μ‘...............................................∫‘¥“/¡“√¥“™ÕË◊ ............................................................................................................................

® ‚ ¥ ® À¡â“¬ ® § Ÿà ¡√ ™ÕË◊ .................................................... ≠— ™“μ.‘ .................................

Õ¬∑Ÿà ∫’Ë “â π/À¡Ÿ∫à “â π..........................................‡≈¢∑Ë.’ .....................................μ√Õ°/´Õ¬......................................∂ππ......................................À¡à∑Ÿ Ë’....................

μ”∫≈/·¢«ß.........................................Õ”‡¿Õ/‡¢μ.........................................®—ßÀ«—¥...........................................À¡“¬‡≈¢‚∑√»æ— ∑.å .....................................

Ù. ¢â“懮ⓢշ ¥ß√“§“∑√—æ¬å∑¢’Ë Õ∑”πμ‘ °‘ √√¡π‡’È ªìπ‡ß‘π.....................................................................∫“∑.............................. μ“ߧå

ı. ¢“â 懮ⓢÕ√∫— √Õß«“à

(Ò) ¢â“懮“â ‰¡à‰¥â√∫— ‚Õπ·∑πÀ√◊Õ‡æ◊ËÕª√–‚¬™π·å °à∫§ÿ §≈μà“ߥ⓫

(Ú) √“§“∑√—æ¬å∑·’Ë  ¥ß‰«â„π Ù. ‡ªìπ√“§“∑’·Ë ∑â®√‘ß

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 «à π¢Õßπ“ß ¢. ®”π«π Ò,  «à π §ß‡¥¡‘

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≈ß™◊ÕË .........................................................................ºŸâ Õ∫ «π

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 ”À√∫— æπ°— ß“π‡®â“Àπ“â ∑Ë’

Ò) √“§“ª√–‡¡‘π∑πÿ ∑√æ— ¬.å ........................................................................................................................∫“∑.................................................................... μ“ߧå
Ú) ‚©π¥∑Ë’¥π‘ „À¡à√–«“ß.............................................................‡≈¢∑¥Ë’ ‘π.............................................................Àπ“â  ”√«®......................................................

‚©π¥∑’¥Ë π‘ ‡≈¢∑’.Ë .......................................................................‡≈à¡......................................................................Àπâ“....................................................................
®”π«π∑¥Ë’ π‘ .......................................................................‰√.à ..................................................................ß“π..................................................................μ“√“ß«“
§ß‡À≈◊Õ..............................................................................‰√à..................................................................ß“π..................................................................μ“√“ß«“
Û) ‰¥®â ¥∑–‡∫’¬π·≈â«·μà«π— ∑Ë.’ .........................................‡¥◊Õπ.............................................................æ.»................................................................

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‡®“â æπ—°ß“π∑¥Ë’ π‘

˘˜Ù

μ«— Õ¬à“ßÀ¡“¬‡≈¢ ı

°√≥’¬ß— ¡’ à«π¢ÕߧŸà ¡√ Õ°’ ΩÉ“¬‡À≈◊ÕÕ¬Ÿà

(∑.¥. Òˆ)

∫π— ∑°÷ ¢Õâ μ°≈ß ·∫ßà ∑√—欠å π‘ √–À«à“ߧŸà ¡√ 

∑Ë’¥‘π
√–«“ß..........................................................................................................μ”∫≈...................................................................................................................
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∑«’Ë “à °“√......................................................................................................
«—π∑Ë.’ ......................‡¥Õ◊ π................................................æ.».................................
‡≈¢ª√–®”μ—«ª√–™“™π
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˘˜ı

μ«— Õ¬à“ßÀ¡“¬‡≈¢ ı

°√≥’¬ß— ¡ ’ «à π¢Õߧࠟ ¡√ Õ’°ΩÉ“¬‡À≈◊ÕÕ¬àŸ

 “√∫—≠®¥∑–‡∫¬’ π

‡πÕÈ◊ ∑¥Ë’ ‘π ‡π◊ÈÕ∑¥Ë’ ‘π
μ“¡ —≠≠“
®¥∑–‡∫’¬π ª√–‡¿∑°“√ §ß‡À≈Õ◊ √–«“ß ‡®â“æπ—°ß“π∑¥Ë’ π‘
«π— ‡¥Õ◊ π ªï ®¥∑–‡∫¬’ π ºâŸ„Àâ ≠— ≠“ ≈ß≈“¬¡◊Õ™◊ÕË
ºâŸ√∫—  ≠— ≠“ ‡≈¢∑Ë’¥‘π ª√–∑—∫μ√“

‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß ‚©π¥∑’¥Ë ‘π„À¡à
«“ «“

«—π∑Ë’.......................... ¢“¬ 𓬠®. Ò. 𓬠°. ı››››› ≈ß™◊ËÕ π“¬  .
‡¥◊Õπ....................... Ú. π“ß ¢.
æ.». .......................

˘˜ˆ «—π∑.Ë’ ......................... ·∫àß∑√—æ¬å π‘ Ò. 𓬠°. Ò. π“ß ¢. ı››››› ≈ß™ÕË◊ ..............................
‡¥◊Õπ....................... √–À«“à ߧ àŸ ¡√  Ú. π“ß ¢. Ú. 𓬠°.
æ.». ....................... 𓬠°. ·∫ßà ∑√æ— ¬ å π‘ √–À«à“ߧŸà ¡√ „À·â °à
π“ß ¢. Ú  à«π „π Ò,  à«π¢Õßμπ
§ß‡À≈◊Õ‡ªπì  à«π¢Õßμπ ¯  «à π  «à π¢Õß
π“ß ¢. ∑¡Ë’ Õ’ ¬Ÿà·≈â« Ò,  «à π §ß‡¥‘¡

μ«— Õ¬à“ßÀ¡“¬‡≈¢ ˆ (∑.¥. Ò)
® ∑Ë’∫“â π
°√≥·’ ∫ßà  ‘π ¡√  ‚¥¬¬° à«π∑‡Ë’ ªìπ

 ‘π ¡√ ∑ßÈ— À¡¥„À·â °àΩ“É ¬„¥Ω“É ¬ÀπßË÷ ® ∑ ’Ë «π/‰√à

‡æ¬’ ßΩÉ“¬‡¥’¬« ® ∑Ë’π“

§”¢Õ®¥∑–‡∫’¬π ‘∑∏·‘ ≈–πμ‘ °‘ √√¡ ® ∑’Ë.............

® πÕ°‡¢μ

μ”·Àπßà ∑’¥Ë ‘π ·≈–°“√ Õ∫ «π ∑‘ ∏„‘ π∑Ë’¥π‘ ª√–‡¿∑..·...∫...àß...∑...√...—æ...¬...å ...‘π...√...–...À...«...“à ..ß...§...àŸ ...¡...√... .... ® „π‡¢μ

‡©æ“– à«π

√–«“ß........................................................................................................................μ”∫≈.......................................................................................................................

‡≈¢∑¥Ë’ π‘ ....................................................................................................................Õ”‡¿Õ.....................................................................................................................

Àπ“â  ”√«®..............................................................................................................®ß— À«¥— ......................................................................................................................

‚©π¥∑¥Ë’ ‘π

𓬠°. · à∫ß∑ —√æ å¬ ‘ π√–À à«“ß§àŸ ¡√ ‡©æ“– à«π¢Õßμπ —∑ÈßÀ¡¥· à° π“ß ¢. ‡∑à“π—Èπ à «π¢Õß∫ÿ§§≈ ◊ËÕπ§ß‡ ‘¥¡ ‡≈¢∑Ë.’ ................................................................................‡≈¡à ...............................................................................Àπâ“..............................................................................
‡ â®“æ —π°ß“π Ë’∑ ‘¥π
®”π«π∑’Ë¥π‘ ....................................................................‰√à...................................................................................ß“π...........................................................μ“√“ß«“

Ò. ¢â“懮⓺⟡’π“¡μàÕ‰ªπÈ’ ¡’§«“¡ª√– ß§å¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡‡°’ˬ«°—∫Õ —ßÀ“√‘¡∑√—æ¬å∑’Ë°≈à“«¢â“ß∫ππ’È

·≈–‰¥ªâ Ø≠‘ “≥μπ·≈«â ¢Õ„À∂â Õâ ¬§”¥«â ¬§«“¡ μ— ¬®å √ß‘ ∂“â ¢“â 懮“â „À∂â Õâ ¬§”‰¡‡à ªπì §«“¡®√ß‘ „Àâ„™∂â Õâ ¬§”π¬’È π— ¢“â 懮“â „π∑“ߧ¥Õ’ “≠“‰¥â

‡≈¢ª√–®”μ«— ª√–™“™π
Ú. ¢â“懮“â ......................Ò.......π...“...¬.....°....................................... ® ®®®® ®®®®® ®® ® ºŸ.â ..∂....Õ◊ ...°...√..√...¡... ...‘∑...∏...‘Ï............

Õ“¬.ÿ ................................ªï  —≠™“μ.‘ ..............................................∫¥‘ “/¡“√¥“™ËÕ◊ ............................................................................................................................

® ‚ ¥ ® À¡“â ¬ ® §Ÿà ¡√ ™ËÕ◊ ...................................................................................................

Õ¬à∑Ÿ ’∫Ë â“π/À¡à∫Ÿ “â π..........................................‡≈¢∑Ë.’ .....................................μ√Õ°/´Õ¬......................................∂ππ......................................À¡àŸ∑Ë’....................

μ”∫≈/·¢«ß.........................................Õ”‡¿Õ/‡¢μ.........................................®ß— À«—¥...........................................À¡“¬‡≈¢‚∑√»—æ∑.å .....................................

‡≈¢ª√–®”μ—«ª√–™“™π
Û. ¢â“懮“â ......................Ò.......π....“..ß.....¢....................................... ® ®®®® ®®®®® ®® ® ºŸâ....√..—∫....‚..Õ...π...........................

Õ“¬ÿ.................................ªï  —≠™“μ‘...............................................∫‘¥“/¡“√¥“™Ë◊Õ............................................................................................................................

® ‚ ¥ ® À¡â“¬ ® § àŸ ¡√ ™Õ◊Ë .................................................... ≠— ™“μ.‘ .................................

Õ¬Ÿ∑à ’Ë∫â“π/À¡Ÿà∫“â π..........................................‡≈¢∑.Ë’ .....................................μ√Õ°/´Õ¬......................................∂ππ......................................À¡∑Ÿà Ë’....................

μ”∫≈/·¢«ß.........................................Õ”‡¿Õ/‡¢μ.........................................®—ßÀ«—¥...........................................À¡“¬‡≈¢‚∑√»—æ∑.å .....................................

Ù. ¢“â 懮“â ¢Õ· ¥ß√“§“∑√—æ¬å∑¢Ë’ Õ∑”πμ‘ °‘ √√¡π‡È’ ªπì ‡ßπ‘ .....................................................................∫“∑.............................. μ“ߧå

ı. ¢“â 懮ⓢÕ√∫— √Õß«à“

(Ò) ¢â“懮“â ‰¡à‰¥√â ∫— ‚Õπ·∑πÀ√◊Õ‡æËÕ◊ ª√–‚¬™π·å °à∫§ÿ §≈μ“à ߥ“â «

(Ú) √“§“∑√æ— ¬∑å ’Ë· ¥ß‰«â„π Ù. ‡ªπì √“§“∑’Ë·∑â®√‘ß
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‰¡¡à ’ ‘ßË ª≈Ÿ° √â“ß „Àâ·°àπ“ß ¢. ‡ªπì ºŸâ∂◊Õ°√√¡ ‘∑∏Ï‘‡æ’¬ß§π‡¥¬’ «

«π— ∑’Ë.......................‡¥◊Õπ................................................æ.».................................
≈ß™Ë◊Õ............................π...“..¬.....°....................................º¢âŸ Õ
≈ß™◊ËÕ............................π...“..ß.....¢....................................º¢âŸ Õ

≈ß™ËÕ◊ .........................................................................ºŸâ Õ∫ «π

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 ”À√∫— æπ—°ß“π‡®“â Àπâ“∑’Ë

Ò) √“§“ª√–‡¡‘π∑ÿπ∑√æ— ¬.å ........................................................................................................................∫“∑.................................................................... μ“ߧå
Ú) ‚©π¥∑’¥Ë ‘π„À¡√à –«“ß.............................................................‡≈¢∑¥Ë’ ‘π.............................................................Àπ“â  ”√«®......................................................

‚©π¥∑¥’Ë ‘π‡≈¢∑’Ë........................................................................‡≈¡à ......................................................................Àπ“â ....................................................................
®”π«π∑¥Ë’ π‘ .......................................................................‰√.à ..................................................................ß“π..................................................................μ“√“ß«“
§ß‡À≈Õ◊ ..............................................................................‰√.à .................................................................ß“π..................................................................μ“√“ß«“
Û) ‰¥â®¥∑–‡∫’¬π·≈â«·μ«à π— ∑Ë.’ .........................................‡¥◊Õπ.............................................................æ.»................................................................

≈ß™◊ËÕ................................................................
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‡®â“æπ°— ß“π∑¥’Ë ‘π

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