รวมระเบียบ คำสั่ง เกี่ยวกับการจดทะเบียนสิทธิและนิติกรรมประเภท ก่อภาระผูกพัน และอื่น ๆ (ปี 2552)

Ò˘¯

μ«— Õ¬à“ßÀ¡“¬‡≈¢ ˘ (∑.¥. Ò)

∑∫Ë’ “â π

∑’Ë «π/‰√à

∑’Ëπ“

∑’Ë..............

§”¢Õ®¥∑–‡∫¬’ π ‘∑∏·‘ ≈–πμ‘ °‘ √√¡ πÕ°‡¢μ
·≈–°“√ Õ∫ «π ‘∑∏‘„π∑¥’Ë π‘ ª√–‡¿∑...≈...¥..‡.ß..‘π...®..“.°...®..”..π..Õ..ß.................. „π‡¢μ

μ”·Àπàß∑Ë’¥‘π

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

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

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

‚©π¥∑’¥Ë ‘π

‡≈¢∑.’Ë ...........................................‡≈¡à ........................................Àπâ“....................................
®”π«π∑¥’Ë π‘ ............Ò.......................‰√.à .............›...................ß“π...............›....................μ“√“ß«“

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

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

Ú. ¢“â 懮â“..............π..“..¬....°............................ ‡≈¢ª√–®”μ—«ª√–™“™π º.Ÿâ ..®..”..π..Õ..ß...........................

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

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

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

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

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

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

‚ ¥ À¡“â ¬ §Ÿà ¡√ ™Ë◊Õ....................................................... ≠— ™“μ.‘ ......................
Õ¬∑àŸ ∫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“â ¢Õ√∫— √Õß«“à

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

(Ú) √“§“∑√—æ¬å∑Ë·’  ¥ß‰«â„π Ù. ‡ªπì √“§“∑’·Ë ∑®â √‘ß
(Û) ‡.¥...‘¡..®..”..π..Õ...ß..μ..“..¡.. ..—≠....≠...“..®..”..π..Õ..ß....≈..ß..«..π—..∑...Ë’ .........‡.¥...Õ◊ ..π...........................æ...»..........................................................................
(Ù) §..Ÿ°à...√..≥...’‰.¥...μâ ..°..≈..ß...≈..¥..®..”..π..«..π...‡.ß..π‘..∑...’ˉ.¥...®â ..”..π..Õ..ß..‡..ª..πì..ª...√..–..°..—π..‰..«..≈â ..ß..‡.À...≈..◊Õ....‡.ª..ìπ...®..”..π..«..π...............................∫..“..∑.............................
(ı) ‡.ß..◊ÕË...π..‰.¢..·...≈..–..¢..âÕ...μ..°..≈..ß...Õ..Ë◊π..Ê....‡.ª..πì...‰.ª..μ...“..¡.. ..≠—....≠...“..®..”.π...Õ..ß..‡.¥...‘¡....................................................................................

«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™ÕË◊ ......................π..“..¬....°.........................ºŸâ¢Õ ®”πÕß
≈ß™ÕË◊ ......................π..“..¬....¢.........................ºŸâ¢Õ √—∫®”πÕß
≈ß™Ë◊Õ......................................................º âŸ Õ∫ «π

(......................................................)
 ”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 ......................................................Àπ“â ..................................................
®”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.»......................

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

μ—«Õ¬“à ßÀ¡“¬‡≈¢ ˘ Ò˘˘

(∑.¥. Òˆ)

∫π— ∑÷°¢âÕμ°≈ß≈¥‡ßπ‘ ®“°®”πÕß

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

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

¢“â 懮“â .....................π..“..¬....°.......º..®Ÿâ..”..π..Õ...ß.................................................... ‡≈¢ª√–®”μ—«ª√–™“™π

.....................π..“..¬....¢.......º..Ÿâ√..—∫..®..”..π...Õ..ß................................................

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

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

μ”∫≈/·¢«ß...............................Õ”‡¿Õ/‡¢μ...............................®—ßÀ«—¥................................À¡“¬‡≈¢‚∑√»—æ∑å..............................
¢//Õ//ª//Ø//≠‘ //“/≥///μ//π//·/≈//–//„/À//â∂//âÕ//¬/§//”//μ/Õà//.....‰..¥..∑â...”.∫...π— ..∑..°÷...¢..âÕ..μ...°..≈..ß..μ..àÕ...‡.®..“â..æ..π...—°..ß..“..π..∑...Ë’¥..‘π.....................................................................................

¥//«â//¬//§//«/“/¡// //μ—//¬//®å /√//ß‘ / ¥ß— μàÕ‰ªπ’È :›
......................∑...’Ë¥..π‘...·..ª..≈...ß..‡.§...√..ËÕ◊...ß..À..¡...“..¬..¢..“â..ß..∫...π..π...È’.¢...â“..æ..‡..®..â“...π...“..¬....°.....º...⟮..”..π..Õ...ß..‰..¥..®â..”..π...Õ..ß..‰..«..â°..∫—....π...“..¬....¢.....º...Ÿ√â ..—∫..®..”..π...Õ..ß....μ...“.¡... ..≠—....≠...“..®..”..π...Õ..ß.........
.≈..ß..«..—π...∑...’Ë.............‡..¥..◊Õ...π......................................æ....»..............................‡..æ..Õ◊Ë...‡.ª...ìπ..ª...√..–..°..π—...À..π...∑’È ..ÿ°...™..π..¥‘...∑..Ë¡’...Õ’ ..¬...à·Ÿ ..≈..«â...À..√..Õ◊...∑..Ë®’..–..‡..°..¥‘...¡..¢’...È÷π..„.π...¿..“..¬...À..π...â“...‡..ª..πì...®..”..π..«..π..............................................∫..“..∑..
.(............................................................................)...∫..¥—...π..’È..¢..“â..æ...‡.®..â“..∑...—Èß.. ..Õ...ß..Ω..“É..¬...‰.¥...μâ ..°...≈..ß..≈...¥..®..”..π...«..π..‡..ß..‘π....∑..Ë’.‰.¥..®â...”..π..Õ...ß..‡.ª...πì ..ª...√..–..°..—π...≈..ß..‡..À..≈...Õ◊ ..‡.ª...ìπ...®..”..π..«..π........................................∫...“..∑......
.(..........................................................................)... ..«à..π...‡.ß..ËÕ◊...π..‰..¢..·..≈...–..¢..âÕ...μ..°...≈..ß..Õ...◊πË ..Ê....§...ß..‡.ª...πì ..‰..ª..μ...“..¡.. ...—≠...≠...“..®..”..π...Õ..ß...‡.¥..¡‘...∑..ÿ°...ª..√..–...°..“..√........................................................
......................∫...—π..∑...÷°..¢..Õâ...μ..°...≈..ß..π...’È∑..”..‰..«..âÀ..π...Ë÷ß..©..∫...—∫....‡.°...Á∫..‰..«..â .≥..... ...”.π...°—..ß..“..π...∑..’Ë¥...‘π....∑..È—ß... ..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..àÕ...À..π...â“..æ..¬...“..π..·...≈..–..‡..®..“â ..æ..π...—°..ß..“..π...∑..Ë’¥...‘π....................................................

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............................................................................................≈..ß...™..Ë◊Õ...........................................................π......“....¬.........°......................................................º..Ÿâ®...”..π..Õ..ß.......................................
............................................................................................≈..ß...™..Ë◊Õ...........................................................π......“....¬.........¢......................................................º..âŸ√..—∫...®..”..π...Õ..ß..................................
............................................................................................≈..ß...™..Ë◊Õ....................................................................................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..Ë◊Õ.....................................................................................................................................æ...¬..“..π...........................................
.............................∫...π— ..∑...÷°..¢..âÕ...μ..°...≈..ß..π...’ȉ..¥..∑â...”..μ..Õà...À..π...“â ......................................................................................................................................
............................................................................................≈..ß...™..◊ËÕ.....................................................................................................................................‡.®..“â..æ...π...°— ..ß..“..π..∑...¥Ë’..π‘..........................
..........................................................................................................ª..√..–..∑...—∫..μ...√..“..μ...”.·...À..π...ßà ..‡.ª...ìπ.. ...”..§..≠—..........................................................

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μ«— Õ¬“à ßÀ¡“¬‡≈¢ ˘ Ú

 “√∫≠— ®¥∑–‡∫’¬π

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

«π— ∑’Ë..................... ≈¥‡ßπ‘ ®“°®”πÕß π“¬ °. 𓬠¢. Ò › › › › › › (≈ß™Ë◊Õ)........................
‡¥◊Õπ................... º√⟠∫— ®”πÕß
æ.». .....................

μ—«Õ¬“à ßÀ¡“¬‡≈¢ Ò ÚÒ

(∑.¥. Ò)

∑∫’Ë “â π

∑Ë’ «π/‰√à

∑’Ëπ“

∑.’Ë .............

§”¢Õ®¥∑–‡∫¬’ π ‘∑∏·‘ ≈–πμ‘ ‘°√√¡ πÕ°‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑¥Ë’ ‘π ª√–‡¿∑...ª...≈..Õ..¥...®..”.π...Õ..ß......................... „π‡¢μ

’∑Ë¥‘π·ª≈ßπÈ’ âæπ®“°®”πÕßμ“¡ —≠≠“®”πÕß ©∫—∫≈ß«—π∑’Ë.........‡ ◊¥Õπ......................æ.»...........μ“¡∫—π∑÷°¢âÕμ°≈ߪ≈Õ¥®”πÕß ≈ß«—π∑’Ë.........‡¥◊Õπ......................æ.»...........μ”·Àπàß∑Ë’¥‘π
‡ ⮓æπ—°ß“π Ë’∑¥‘π
√–«“ß......................................................................................... μ”∫≈.........................................................................................

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

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

‚©π¥∑¥’Ë ‘π

‡≈¢∑Ë’............................................‡≈¡à ........................................Àπâ“....................................
®”π«π∑’¥Ë π‘ .................Ò..................‰√à................›.................ß“π................›...................μ“√“ß«“

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

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

Ú. ¢“â 懮“â ..............π..“..¬...¢............................. ‡≈¢ª√–®”μ—«ª√–™“™π º.Ÿâ ..√..—∫..®..”..π..Õ...ß......................

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

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

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

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

Û. ¢â“懮â“...............π..“..¬....°........................... ‡≈¢ª√–®”μ—«ª√–™“™π ºâŸ...®..”..π..Õ...ß..........................

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

‚ ¥ À¡“â ¬ §à Ÿ ¡√ ™Õ◊Ë ....................................................... ≠— ™“μ‘.......................
Õ¬à∑Ÿ ’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.....................

Ù. ¢“â 懮“â ¢Õ· ¥ß√“§“∑√æ— ¬∑å Ë’¢Õ∑”πμ‘ °‘ √√¡πÈ’‡ªπì ‡ß‘π.............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à

(Ò) ¢â“懮“â ‰¡à‰¥â√∫— ‚Õπ·∑πÀ√Õ◊ ‡æÕ◊Ë ª√–‚¬™π·å °à∫§ÿ §≈μ“à ߥ“â «
(Ú) √“§“∑√—æ¬å∑’·Ë  ¥ß‰«â„π Ù. ‡ªπì √“§“∑’·Ë ∑â®√ß‘
(Û) .....................................................................................................................................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................

«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™◊ËÕ......................π..“..¬....¢........................ºŸâ¢Õ √∫— ®”πÕß
≈ß™ËÕ◊ ......................π..“..¬....°.........................ºâŸ¢Õ ®”πÕß
≈ß™ËÕ◊ ......................................................º âŸ Õ∫ «π

(......................................................)
 ”À√∫— æπ°— ß“π‡®“â Àπ“â ∑’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™ÕË◊ .......................................................
(......................................................)
‡®â“æπ—°ß“π∑’Ë¥‘π

ÚÚ

μ—«Õ¬“à ßÀ¡“¬‡≈¢ Ò

(∑.¥. Òˆ)

∫π— ∑÷°¢âÕμ°≈ߪ≈Õ¥®”πÕß

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

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

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

.....................π..“..¬....°.......º..®âŸ ..”..π..Õ...ß....................................................

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

Õ¬Ÿà∑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..............................
¢//Õ//ª//Ø//≠‘ //“/≥///μ//π//·/≈//–//„/À//â∂//Õâ //¬/§//”//μ/Õà//.....‰..¥..∑â...”.∫...π— ..∑..°÷...¢..Õâ ..μ...°..≈..ß..μ..Õà...‡.®..â“..æ..π...°— ..ß..“..π..∑...Ë¥’ ..‘π.....................................................................................

¥//«â//¬//§//«/“/¡// //μ—//¬//å®/√//ß‘ / ¥—ßμÕà ‰ªπÈ’ :›
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μ...≈..Õ...¥..·...≈..«â....®..ß÷..≈...ß..≈..“..¬...¡..Õ◊...™..ÕË◊ ..À...√..Õ◊..≈...ß..≈..“..¬...æ..¡‘...æ...åπ..‘«È..¡...◊Õ..‰.«...â‡.ª..ìπ...À..≈...°— ..∞..“..π...μ..àÕ...À..π...“â ..æ..¬...“..π..·...≈..–..‡..®..“â ..æ..π...—°..ß..“..π...∑..Ë¥’...‘π....................................................

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............................................................................................≈..ß...™..Ë◊Õ...........................................................π......“....¬.........¢......................................................º..√âŸ..—∫...®..”..π...Õ..ß..................................
............................................................................................≈..ß...™..Ë◊Õ...........................................................π......“....¬.........°......................................................º..Ÿâ®...”..π..Õ..ß.......................................
............................................................................................≈..ß...™..Ë◊Õ....................................................................................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..Ë◊Õ.....................................................................................................................................æ...¬..“..π...........................................
.............................∫...—π..∑...÷°..¢...Õâ ..μ...°..≈..ß..π...È’‰..¥..∑â...”..μ..Õà...À..π...“â ......................................................................................................................................
............................................................................................≈..ß...™..Ë◊Õ.....................................................................................................................................‡.®..“â..æ...π...°— ..ß..“..π..∑...¥’Ë..π‘..........................
..........................................................................................................ª..√..–..∑...—∫..μ...√..“..μ...”.·...À..π...ßà ..‡.ª...πì.. ...”..§..≠—..........................................................

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μ«— Õ¬à“ßÀ¡“¬‡≈¢ Ò

 “√∫≠— ®¥∑–‡∫¬’ π

®¥∑–‡∫¬’ π ª√–‡¿∑°“√ ºâŸ„À â ≠— ≠“ ºâŸ√—∫ —≠≠“ ‡πÈ◊Õ∑Ë’¥‘π ‡πÈ◊Õ∑’Ë¥‘π √–«“ß ‡®â“æπ—°ß“π∑Ë’¥‘π
«—𠇥Õ◊ π ªï ®¥∑–‡∫’¬π μ“¡ —≠≠“ §ß‡À≈Õ◊ ‡≈¢∑Ë’¥‘π ≈ß≈“¬¡Õ◊ ™ÕË◊
𓬠¢. 𓬠°. ‚©π¥∑¥Ë’ ‘π„À¡à ª√–∑∫— μ√“
«—π∑.’Ë .................... ª≈Õ¥®”πÕß ºâŸ√—∫®”πÕß ‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
‡¥◊Õπ................... «“ «“
æ.». .....................
Ò››››› › (≈ß™◊ËÕ)........................

∑’Ë¥‘π·ª≈ßπÈæ’ πâ ®“°°“√®”πÕßμ“¡ ≠— ≠“
®”πÕß ©∫∫— ≈ß«π— ∑.’Ë ............‡¥◊Õπ.....................
æ.»...............μ“¡∫π— ∑÷°¢âÕμ°≈ª≈Õ¥®”πÕß
≈ß«—π∑.’Ë ......‡¥Õ◊ π.........................æ.».............

ÚÛ

ÚÙ

μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÒÒ (∑.¥. Ò)

∑∫’Ë “â π

∑Ë’ «π/‰√à

∑Ë’π“

∑’Ë..............

§”¢Õ®¥∑–‡∫¬’ π ∑‘ ∏·‘ ≈–π‘μ°‘ √√¡ πÕ°‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑¥’Ë ‘π ª√–‡¿∑...‚..Õ..π..™..”..√..–..À...π..®’È..”..π..Õ..ß................ „π‡¢μ

μ”·Àπàß∑’Ë¥‘π

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

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

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

‚©π¥∑¥’Ë π‘

‡≈¢∑’Ë............................................‡≈à¡........................................Àπ“â ....................................
®”π«π∑’¥Ë ‘π.................Ò..................‰√.à ...............›.................ß“π................›...................μ“√“ß«“

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

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

Ú. ¢“â 懮“â ..............π..“..¬....°............................ ‡≈¢ª√–®”μ—«ª√–™“™π ºŸâ...‚.Õ...π...............................

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

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

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.....................

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

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

‚ ¥ À¡“â ¬ § àŸ ¡√ ™ÕË◊ ....................................................... ≠— ™“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“â ¢Õ· ¥ß√“§“∑√æ— ¬∑å Ë¢’ Õ∑”π‘μ‘°√√¡π‡’È ªìπ‡ßπ‘ .............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à

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

(Ú) √“§“∑√æ— ¬å∑Ë’· ¥ß‰«â„π Ù. ‡ªìπ√“§“∑·’Ë ∑®â √‘ß
(Û) . ..ß‘Ë..ª..≈...Ÿ°.. ..√..â“..ß..„.π...∑..Ë’¥...‘π..·..ª..≈...ß..π..’ȉ..¡..à¡..’.....................................................................................................................
(Ù) .°..“..√..‚.Õ..π...√..“..¬..π..’È‚..Õ..π..‡..æ..Õ◊Ë..™...”.√..–..À...π..®È’..”..π..Õ...ß..μ..“..¡.. ...—≠...≠...“..®..”..π..Õ..ß....≈..ß..«..π—..∑...’Ë ...........‡.¥...Õ◊ ..π.........................æ....»...................................

.‚.¥..¬...º..√âŸ..—∫..‚..Õ..π..´...Ë÷ß..‡.ª..ìπ...º..Ÿ√â..—∫..®..”..π...Õ..ß..¬..Õ...¡..‡.æ...Ë¡‘ ..‡.ß..‘π...„.À..·â...°..ºà ..⟂..Õ..π..´..Ë÷ß..‡..ª..ìπ..º...®âŸ ..”..π..Õ..ß..‡..ª..ìπ..‡..ß..π‘ ...................................................∫..“..∑.......................
«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................

≈ß™◊ÕË ......................π..“..¬....°.........................ºâŸ¢Õ ‚Õπ
≈ß™◊ÕË ......................π..“..¬....¢.........................ºâŸ¢Õ √—∫‚Õπ
≈ß™◊ËÕ......................................................º Ÿâ 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 ......................................................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™◊ÕË .......................................................
(......................................................)
‡®â“æπ—°ß“π∑’Ë¥‘π

μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÒÒ Úı

(∑.¥. Òˆ)

∫—π∑°÷ ¢âÕμ°≈ß‚Õπ™”√–Àπ’È®”πÕß

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

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

¢“â 懮“â .....................π..“..¬....°.......º..⟂.Õ...π......................................................... ‡≈¢ª√–®”μ—«ª√–™“™π

.....................π..“..¬....¢.......º..âŸ√..∫— ..‚..Õ..π.....................................................

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

Õ¬Ÿà∑’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..............................
¢//Õ//ª//Ø//‘≠//“/≥///μ//π//·/≈//–//„/À//â∂//âÕ//¬/§//”//μ/Õà//.....‰..¥..â∑...”.∫...π— ..∑..÷°...¢..âÕ..μ...°..≈..ß..μ..àÕ...‡.®..â“..æ..π...°— ..ß..“..π..∑...¥Ë’ ..‘π.....................................................................................

¥//«â//¬//§//«/“/¡// //—μ//¬//å®/√//ß‘ / ¥ß— μàÕ‰ªπÈ’ :›

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.(............................................................)...∫..¥—...π..’È..¢..“â..æ...‡.®..“â..∑...ß—È .. ..Õ...ß..Ω..“É..¬...μ..°...≈..ß..‚..Õ..π...∑..’¥Ë...‘π..√..“..¬..π...’™È..”..√..–..À...π..®’È...”..π..Õ..ß...·..°..°à...—π..„..À..â‡.. ..√..®Á.. ...‘πÈ ..‰..ª....‚.¥...¬..„.π...°..“..√..‚..Õ..π...™..”..√..–..À...π..È®’..”..π...Õ..ß..π..È’
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.μ..≈..Õ...¥..·...≈..â«....®..÷ß..≈...ß..≈..“..¬...¡..◊Õ...™..ËÕ◊ ..À...√..Õ◊..≈...ß..≈..“..¬...æ..‘¡...æ...πå ..‘«È..¡...Õ◊ ..‰.«...â‡.ª..ìπ...À..≈...°— ..∞..“..π...μ..àÕ...À..π...“â ..æ..¬...“..π..·...≈..–..‡..®..“â ..æ..π...°— ..ß..“..π...∑..’¥Ë...π‘ ....................................................

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............................................................................................≈..ß...™..Ë◊Õ...........................................................π......“....¬.........¢......................................................º..√âŸ..∫—...‚.Õ...π.......................................
............................................................................................≈..ß...™..◊ËÕ....................................................................................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..◊ËÕ.....................................................................................................................................æ...¬..“..π...........................................
.............................∫...—π..∑...°÷ ..¢..Õâ...μ..°...≈..ß..π...È’‰..¥..∑â...”..μ..Õà...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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μ—«Õ¬“à ßÀ¡“¬‡≈¢ ÒÒ Úˆ

 “√∫—≠®¥∑–‡∫’¬π

®¥∑–‡∫’¬π ª√–‡¿∑°“√ ºŸâ„À â ≠— ≠“ ºŸâ√—∫ —≠≠“ ‡πÈ◊Õ∑Ë’¥‘π ‡πÈ◊Õ∑’Ë¥‘π √–«“ß ‡®â“æπ—°ß“π∑Ë’¥‘π
«—𠇥Õ◊ π ªï ®¥∑–‡∫¬’ π μ“¡ —≠≠“ §ß‡À≈Õ◊ ‡≈¢∑Ë’¥‘π ≈ß≈“¬¡Õ◊ ™Õ◊Ë
‚©π¥∑’Ë¥‘π„À¡à ª√–∑∫— μ√“
‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
«“ «“

«—π∑Ë.’ .................... ‚Õπ™”√–ÀπÈ’®”πÕß π“¬ °. 𓬠¢. Ò››››› › (≈ß™◊ËÕ)........................
‡¥Õ◊ π...................
æ.». .....................

μ—«Õ¬“à ßÀ¡“¬‡≈¢ ÒÚ Ú˜

(∑.¥. Ò)

∑∫’Ë “â π

∑Ë’ «π/‰√à

∑Ë’π“

∑.Ë’ .............

§”¢Õ®¥∑–‡∫’¬π ∑‘ ∏‘·≈–πμ‘ ‘°√√¡ πÕ°‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑¥Ë’ ‘π ª√–‡¿∑...·..∫...àß..‚.Õ...π..™..”..√..–..À..π...È’®..”.π...Õ..ß......... „π‡¢μ

μ”·Àπàß∑Ë’¥‘π

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

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

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

‚©π¥∑’Ë¥‘π

‡≈¢∑.’Ë ...........................................‡≈¡à ........................................Àπ“â ....................................
®”π«π∑¥’Ë ‘π.................Ò..................‰√à................›.................ß“π................›...................μ“√“ß«“

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

‰¥âªØ≠‘ “≥μπ·≈â« ¢Õ„Àâ∂âÕ¬§”¥â«¬§«“¡ —쬮å √‘ß ∂“â ¢“â 懮“â „Àâ∂Õâ ¬§”‰¡‡à ªπì §«“¡®√‘ß„Àâ„™∂â âÕ¬§”π¬’È π— ¢“â 懮Ⓞπ∑“ߧ¥Õ’ “≠“‰¥â

Ú. ¢â“懮â“..............π..“..¬...°............................. ‡≈¢ª√–®”μ—«ª√–™“™π ºŸâ...‚.Õ..π................................

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

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

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

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

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

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

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

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

μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®ß— À«¥— .................................À¡“¬‡≈¢‚∑√»æ— ∑.å ....................
Ù. ¢â“懮ⓢշ ¥ß√“§“∑√æ— ¬å∑¢Ë’ Õ∑”πμ‘ °‘ √√¡πȇ’ ªìπ‡ßπ‘ .............................›............................∫“∑.........›........... μ“ߧå

ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à

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

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

(Û) . ..‘Ëß..ª..≈...Ÿ°.. ..√..â“..ß..„.π...∑..’¥Ë..π‘...·..ª..≈...ß..π..’ȉ..¡..¡à..’.....................................................................................................................

(Ù) °...“..√..‚.Õ..π...√..“.¬...π..’È‚.Õ...π..‡.æ...ÕË◊ ..·..∫...àß..™..”..√..–..À..π...’È®..”.π...Õ..ß..μ...“.¡... ..—≠...≠...“..®..”..π..Õ...ß...≈...ß..«..—π..∑..Ë.’..................‡..¥..Õ◊..π................................æ.....»............................................

.‡.©..æ...“.–..‚..©..π..¥...∑..’Ë¥...‘π..‡.≈..¢...∑...Ë’.........................‡.ª...πì ..®..”..π..«..π...‡.ß..‘π..................................∫..“..∑.... ..à«..π..‚..©..π..¥...∑..¥’Ë ..π‘...‡.≈..¢..∑....’Ë .......................¬..—ß..§...ß..®..”..π..Õ..ß..‡..ª..πì..ª...√..–..°..π—..

Àπ∑È’ ’ˇÀ≈Õ◊ Õ¬®àŸ ”π«π......................∫“∑ ‡ß◊ËÕπ‰¢·≈– «π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................

¢âÕμ°≈ßÕπ◊Ë Ê „À‡â ªπì ‰ªμ“¡ —≠≠“®”πÕ߇¥‘¡ ≈ß™ËÕ◊ ......................π..“..¬....°.........................ºŸâ¢Õ ‚Õπ

∑°ÿ ª√–°“√ ≈ß™Ë◊Õ......................π..“..¬....¢.........................ºŸâ¢Õ √—∫‚Õπ

≈ß™ÕË◊ ......................................................º Ÿâ Õ∫ «π

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

 ”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...............................................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 ·μ«à π— ∑’.Ë ................................‡¥Õ◊ π............................................æ.»......................

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

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

‡®â“æπ—°ß“π∑’Ë¥‘π

Ú¯

μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÒÚ

(∑.¥. Òˆ)

∫—π∑°÷ ¢Õâ μ°≈ß·∫ßà ‚Õπ™”√–Àπ’®È ”πÕß

∑Ë’¥‘π
√–«“ß...............................................................................μ”∫≈........................................................................
‡≈¢∑’¥Ë π‘ ...............................Àπ“â  ”√«®............................Õ”‡¿Õ.......................................................................
‚©π¥À¡“¬‡≈¢∑.’Ë ..............................................................®—ßÀ«—¥.......................................................................
∑’Ë«“à °“√.....................................................................

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

¢“â 懮“â .....................π..“..¬....°.......º..Ÿâ‚.Õ...π......................................................... ‡≈¢ª√–®”μ—«ª√–™“™π

.....................π..“..¬....¢.......º..âŸ√..∫— ..‚..Õ..π.....................................................

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

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

μ”∫≈/·¢«ß...............................Õ”‡¿Õ/‡¢μ...............................®—ßÀ«¥— ................................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— μÕà ‰ªπÈ’ :›
......................∑...’¥Ë ..π‘...·..ª..≈...ß..‡.§...√..Ë◊Õ...ß..À..¡...“..¬..¢..â“..ß..∫...π..π...’È.¢...â“..æ..‡..®..“â ...π...“..¬....°.....º...⟮..”..π..Õ...ß....‰.¥...®â ..”..π..Õ...ß..‰.«..â°...—∫....π..“..¬....¢......º..√âŸ..∫—...®..”..π..Õ...ß....‚.¥..¬...‰.¥...â®..”..π..Õ...ß..√..«..¡...‰.«..°â...—∫
.‚.©..π...¥..∑...’Ë¥..‘π...‡.≈...¢..∑..Ë.’...................................√..«..¡.................................‚..©..π...¥....μ..“..¡... ..—≠...≠....“..®..”..π..Õ...ß..≈..ß...«..π— ..∑....Ë’ ....................‡.¥...Õ◊..π..............................................æ....»........................‡..æ..◊ÕË...‡.ª...ìπ..ª...√..–..°...π— ..°..“..√..°...⬟ ..◊¡...‡.ß..π‘..
.´..ß÷Ë ..º..⮟...”..π..Õ...ß..‰.¥...°â ..Ÿâ¬..¡◊...‰.ª...®..“..°..º...√⟠..∫—...®..”..π..Õ...ß...‡..ª..πì...®..”..π..«..π.................................................∫...“..∑....(..........................................................)...∫...—¥..π...’È .¢...“â .æ...‡.®...“â ..∑..Èß—.. ...Õ..ß..Ω...É“..¬..μ...°..≈..ß...‚.Õ...π..∑..Ë’¥...‘π..√...“..¬..π..’È.
.·..∫..ßà...™..”..√..–..À...π..’È®..”..π...Õ..ß..·...°..°à..—π...∫..“..ß... ..à«..π....‡.ª...πì..®...”..π..«..π...‡.ß..π‘.................................................................∫...“..∑....(........................................................................................)... ...à«..π..‚..©..π...¥..∑...¥Ë’ ..‘π...‡.≈..¢...∑..Ë.’.......................................
.§..ß..®..”..π...Õ..ß..‡..ª..πì...ª..√..–...°..—π..À...π..∑’È...‡Ë’.À...≈..◊Õ...Õ..¬...Ÿà®..”..π..«..π............................................∫..“..∑....(..............................................)...‡..ß..ËÕ◊ ..π...‰.¢..·...≈..–..¢...Õâ ..μ...°..≈..ß...Õ..◊Ëπ...Ê...„..À..‡â..ª..πì...‰.ª...μ..“..¡... ..—≠...≠....“..®..”..π..Õ...ß..‡.¥...¡‘..
.∑..ÿ°..ª...√..–..°...“..√................................................................................................................................................................................................
......................∫...π— ..∑...÷°..¢..Õâ...μ..°...≈..ß..π...∑È’ ..”..‰..«..Àâ ..π...Ëß÷ ..©..∫...—∫....‡.°...∫Á ..‰..«..â .≥..... ...”.π...—°..ß..“..π...∑..¥Ë’...‘π....∑..Èß—... ..Õ..ß...Ω..É“..¬..‰..¥..âμ...√..«..®..¥...Ÿ∫..π—...∑..÷°...¢..Õâ..μ...°..≈...ß...·...≈..–..‡..¢..â“..„.®...¢..âÕ..§...«..“..¡........
μ...≈..Õ...¥..·...≈..â«....®..ß÷..≈...ß..≈..“..¬...¡..Õ◊...™..ÕË◊ ..À...√..◊Õ..≈...ß..≈..“..¬...æ..‘¡...æ...åπ..‘È«..¡...Õ◊ ..‰.«...‡â .ª..πì...À..≈...—°..∞..“..π...μ..àÕ...À..π...â“..æ..¬...“..π..·...≈..–..‡..®..“â ..æ..π...—°..ß..“..π...∑..¥Ë’...π‘ ....................................................

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............................................................................................≈..ß...™..Ë◊Õ...........................................................π......“....¬.........°......................................................º..âŸ.‚.Õ..π............................................
............................................................................................≈..ß...™..◊ËÕ...........................................................π......“....¬.........¢......................................................º..√Ÿâ...∫— ..‚..Õ..π.......................................
............................................................................................≈..ß...™..◊ËÕ....................................................................................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..Ë◊Õ.....................................................................................................................................æ...¬..“..π...........................................
.............................∫...π—..∑...÷°..¢...âÕ..μ...°..≈..ß..π...È’‰..¥..∑â...”..μ..Õà...À..π...“â ......................................................................................................................................
............................................................................................≈..ß...™..◊ËÕ.....................................................................................................................................‡.®...“â .æ...π...°— ..ß..“..π...∑..¥’Ë...π‘ .........................
..........................................................................................................ª..√..–..∑...∫— ..μ...√..“..μ...”.·...À..π...àß..‡.ª...πì .. ...”..§..≠—..........................................................

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μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÒÚ

 “√∫≠— ®¥∑–‡∫’¬π

®¥∑–‡∫¬’ π ª√–‡¿∑°“√ ºâŸ„À â ≠— ≠“ ºŸâ√—∫ —≠≠“ ‡πÈ◊Õ∑’Ë¥‘π ‡πÈ◊Õ∑Ë’¥‘π √–«“ß ‡®â“æπ—°ß“π∑Ë’¥‘π
«—𠇥Õ◊ π ªï ®¥∑–‡∫¬’ π μ“¡ —≠≠“ §ß‡À≈Õ◊ ‡≈¢∑’Ë¥‘π ≈ß≈“¬¡Õ◊ ™Õ◊Ë
‚©π¥∑¥Ë’ ‘π„À¡à ª√–∑∫— μ√“
‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
«“ «“

«—π∑.Ë’ .................... ·∫àß‚Õπ™”√–Àπ’È π“¬ °. 𓬠¢. Ò››››› › (≈ß™Ë◊Õ)........................
‡¥Õ◊ π................... ®”πÕß
æ.». .....................

Ú˘

ÚÒ

μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÒÛ (∑.¥. Ò)

∑∫’Ë “â π

∑ ’Ë «π/‰√à

∑Ë’π“

∑.Ë’ .............

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

·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑¥Ë’ π‘ ª√–‡¿∑...À..≈...ÿ¥..‡.ª...ìπ.. ..‘∑...∏..‘®..“..°..®..”..π..Õ...ß........ „π‡¢μ

μ”·Àπàß∑’Ë¥‘π (μ“¡§”ææ‘ “°…“»“≈.......................)

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

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

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

‚©π¥∑Ë¥’ ‘π

‡≈¢∑’.Ë ...........................................‡≈¡à ........................................Àπâ“....................................
®”π«π∑¥Ë’ π‘ .................Ò..................‰√.à ...............›.................ß“π................›...................μ“√“ß«“

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

‰¥âªØ≠‘ “≥μπ·≈â« ¢Õ„Àâ∂âÕ¬§”¥«â ¬§«“¡ μ— ¬®å √ß‘ ∂“â ¢â“懮ⓄÀâ∂âÕ¬§”‰¡‡à ªì𧫓¡®√‘ß„Àâ„™∂â Õâ ¬§”πȬ’ —π¢â“懮“â „π∑“ߧ¥’Õ“≠“‰¥â

Ú. ¢â“懮“â ..............π..“..¬....°............................ ‡≈¢ª√–®”μ—«ª√–™“™π ºâ.Ÿ ..®..”..π..Õ..ß...........................

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

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

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

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

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

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

‚ ¥ À¡“â ¬ §Ÿ à ¡√ ™ËÕ◊ ....................................................... ≠— ™“μ.‘ ......................
Õ¬à∑Ÿ 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ⓢշ ¥ß√“§“∑√—æ¬å∑’Ë¢Õ∑”πμ‘ °‘ √√¡π‡È’ ªìπ‡ßπ‘ .............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à

(Ò) ¢â“懮“â ‰¡à‰¥√â —∫‚Õπ·∑πÀ√◊Õ‡æÕ◊Ë ª√–‚¬™πå·°∫à §ÿ §≈μ“à ߥ“â «
(Ú) √“§“∑√—æ¬∑å ·Ë’  ¥ß‰«â„π Ù. ‡ªìπ√“§“∑Ë·’ ∑â®√‘ß
(Û) À...≈..¥ÿ..‡..ª..ìπ.. ...‘∑..∏..®‘..“..°..®..”..π..Õ...ß..μ..“..¡.. ...≠— ...≠...“..®..”..π..Õ...ß...≈..ß..«..—π...∑..Ë’..........‡.¥...◊Õ..π.........................æ....».......................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................

«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
≈ß™ÕË◊ ...‚.Õ..π...μ..“..¡..§..”..æ...æ‘ ..“..°..…...“..»..“..≈..................................ºŸâ¢Õ ‚Õπ
≈ß™◊ËÕ......................π..“..¬....¢.........................ºâŸ¢Õ √—∫®”πÕß
≈ß™ËÕ◊ ......................................................º Ÿâ 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.’ ................................‡¥◊Õπ............................................æ.»......................

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

μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÒÛ ÚÒÒ

(∑.¥. ˘)

§”¢Õ..À...≈..¥ÿ...‡.ª...ìπ.. ..‘∑...∏..‘®..“..°..®..”..π...Õ..ß.......................

(μ“¡§”ææ‘ “°…“»“≈...................................)

©∫∫— ∑.’Ë ......................................

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

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

¢“â 懮â“...........................π..“..¬....¢................................................................. ‡≈¢ª√–®”μ—«ª√–™“™π

Õ“¬.ÿ .....Û.........ªï ‡™È◊Õ™“μ‘...........‰.∑..¬............... —≠™“μ.‘ .........‰.∑...¬...............∫¥‘ “/¡“√¥“™ÕË◊ .....................................................................

Õ¬Ÿà∑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 ......................

¢Õ¬πË◊ §”¢ÕμÕà ‡®â“æπ°— ß“π∑Ë’¥π‘ ®—ßÀ«¥— ....................................................¥â«¬§«“¡ μ— ¬å®√ß‘ «“à :-
¢Õâ Ò. ¥â«¬....∑..’¥Ë ..‘π...·..ª..≈...ß..‡.§..√..ËÕ◊...ß..À..¡..“..¬..¢...“â .ß..∫...π..π..’È..¡..™’..◊ÕË....π..“..¬....°.....‡..ª..πì..º...Ÿ∂â ..◊Õ..°...√..√..¡.. ..‘∑...∏..Ï‘ .π..“..¬....°.....‰..¥..®â..”..π..Õ...ß..‰.«..°â..∫—...¢..â“..æ..‡.®..“â..μ...“..¡.....

. ..—≠...≠...“..®..”..π..Õ...ß...≈..ß..«..π—...∑..Ë’...................‡.¥...Õ◊ ..π............................................................æ....».........................∫...¥— ..π..’È..»..“..≈..‰..¥..â¡..§’...”..æ..æ‘...“..°..…..“..„.À...â∑..’¥Ë..‘π...·..ª..≈...ß..π..È’À..≈...ÿ¥..‡.ª...πì .. ..∑‘...∏..·‘ ..°..à¢...â“.æ...‡.®..“â..μ..“..¡.....
.π..—¬..¡..“..μ...√..“...˜...Ú..˘....·..À...àß..ª..√..–..¡...«..≈..°..Æ...À..¡..“..¬..·...æ..ßà..·..≈...–..æ..“..≥...‘™..¬...å .μ...“.¡...§..”..æ..æ‘...“..°..…..“..»...“.≈.........................................................................................................

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¢âÕ Ú. ©–ππ—È ¢Õ„À‡â ®“â æπ°— ß“π∑¥Ë’ π‘ ...¥...”.‡..π..π‘..°...“.√..®...¥..∑..–..‡..∫..¬’..π...À..≈..¥ÿ...‡.ª..πì... ..‘∑..∏...®‘ ..“.°...®..”..π..Õ..ß..·...°..à¢..“â..æ..‡..®..â“..„.À..âª...√..“.°...Ø..„.π...‚.©..π...¥..∑...¥Ë’ ..π‘...

.·..ª..≈..ß..π...’¥È ..«â..¬.....................................................................................................................................................................................

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.......................π..“..¬....¢.......................... ºâŸ¢Õ
........................................................ 欓π
........................................................ 欓π

μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÒÛ ÚÒÚ

 “√∫≠— ®¥∑–‡∫’¬π

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

«π— ∑Ë.’ .................... À≈ÿ¥‡ªìπ ∑‘ ∏‘®“° 𓬠°. 𓬠¢. Ò››››› › (≈ß™ËÕ◊ )........................
‡¥◊Õπ................... ®”πÕß (μ“¡
æ.»...................... §”æ‘æ“°…“»“≈.....

......................)

μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÒÙ ÚÒÛ

(∑.¥. Ò)

(°√≥’‚Õπ‚¥¬μ°≈ß°π— ) ∑∫’Ë “â π
∑’ Ë «π/‰√à

∑Ë’π“

∑’Ë..............

§”¢Õ®¥∑–‡∫¬’ π ∑‘ ∏·‘ ≈–π‘μ‘°√√¡ πÕ°‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑Ë’¥‘π ª√–‡¿∑...‚..Õ..π.. ..‘∑...∏..°‘..“..√..√..∫—..®...”.π...Õ..ß........... „π‡¢μ

μ”·Àπàß∑Ë’¥‘π

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

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

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

‚©π¥∑’¥Ë ‘π

‡≈¢∑.Ë’ ...........................................‡≈¡à ........................................Àπ“â ....................................
®”π«π∑’¥Ë π‘ .................Ò..................‰√à................›.................ß“π................›...................μ“√“ß«“

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

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

Ú. ¢“â 懮â“..............π..“..¬...¢............................. ‡≈¢ª√–®”μ—«ª√–™“™π ºâŸ...√..∫— ..®..”..π..Õ...ß......................

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

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

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

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

Û. ¢â“懮â“...............π..“..¬....§........................... ‡≈¢ª√–®”μ—«ª√–™“™π º.⟠..√..—∫...‚.Õ..π...........................

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

‚ ¥ À¡“â ¬ §Ÿà ¡√ ™ËÕ◊ ....................................................... —≠™“μ.‘ ......................
Õ¬Ÿ∑à ’∫Ë â“π/À¡∫àŸ 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∑”π‘μ°‘ √√¡π’ȇªπì ‡ß‘π.............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à

(Ò) ¢“â 懮Ⓣ¡à‰¥√â —∫‚Õπ·∑πÀ√◊Õ‡æËÕ◊ ª√–‚¬™π·å °à∫§ÿ §≈μà“ߥ“â «
(Ú) √“§“∑√æ— ¬∑å ’·Ë  ¥ß‰«â„π Ù. ‡ªπì √“§“∑’Ë·∑®â √ß‘
(Û) ‡.ª...πì ..°..“..√..‚.Õ...π.. ..∑‘...∏..°‘ ..“..√..√..∫— ..®..”..π...Õ..ß...μ...“..¡.. ..—≠...≠....“.®...”.π...Õ..ß...≈...ß..«..π— ..∑..Ë.’ ..............‡.¥..Õ◊...π.....................................æ...»..................................

‚.¥...¬..∑..Ë’‡..À..μ..ºÿ...Ÿâ‚.Õ..π...‰.¥...â ......................................................................................................................................................
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«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™ËÕ◊ ......................π..“..¬....¢.........................ºŸâ¢Õ √∫— ®”πÕß
≈ß™ËÕ◊ ......................π..“..¬...§..........................ºŸâ¢Õ √—∫‚Õπ
≈ß™ËÕ◊ ......................................................º Ÿâ Õ∫ «π

(......................................................)
 ”À√—∫æπ—°ß“π‡®“â Àπ“â ∑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«“

°√≥’ÕπË◊ „Àâ‡∑¬’ ∫‡§’¬ß

Û) ‰¥®â ¥∑–‡∫¬’ π·≈â«·μà«π— ∑Ë.’ ................................‡¥◊Õπ............................................æ.»......................
≈ß™ÕË◊ .......................................................
(......................................................)
‡®â“æπ—°ß“π∑’Ë¥‘π

ÚÒÙ

μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÒÙ

(∑.¥. Òˆ)

∫—π∑÷°¢Õâ μ°≈ß‚Õπ ‘∑∏‘°“√√—∫®”πÕß

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

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

¢“â 懮“â .....................π..“..¬....¢......º..âŸ√..∫—..®..”..π...Õ..ß................................................ ‡≈¢ª√–®”μ—«ª√–™“™π

.....................π..“..¬....§.......º..âŸ√..—∫...‚.Õ..π.....................................................

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

Õ¬∑Ÿà 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 .............................
¢//Õ//ª//Ø//‘≠//“/≥///μ//π//·/≈//–//„/À//∂â //âÕ//¬/§//”//μ/àÕ//.....‰..¥..â∑...”.∫...—π..∑..÷°...¢..Õâ ..μ...°..≈..ß..μ..àÕ...‡.®..“â..æ..π...°— ..ß..“..π..∑...Ë’¥..π‘.....................................................................................

¥//«â//¬//§//«/“/¡// //—μ//¬//å®/√//ß‘ / ¥ß— μàÕ‰ªπÈ’ :›

......................μ...“..¡..∑...Ë¢’ ..â“..æ..‡..®..“â...π...“..¬....¢....‰..¥..√â..—∫...®..”..π...Õ..ß..∑...’¥Ë ..π‘...·..ª...≈..ß..‡..§..√..◊ÕË...ß..À..¡...“..¬..¢..â“..ß...∫..π...π..’®È..“..°...π..“..¬....°.....μ..“..¡... ..—≠...≠....“..®..”..π..Õ...ß..≈..ß...«..π— ..∑...’Ë ........................
.‡.¥..Õ◊...π..........................................................æ....»............................∫...—¥..π...’È .¢...“â .æ...‡.®...â“...π...“..¬...¢......º...Ÿ√â ..—∫..®..”..π...Õ..ß....°..—∫....π...“..¬....§......º..Ÿâ√..—∫...‚.Õ...π....‰.¥...âμ..°..≈...ß..¬..‘π...¬..Õ...¡..°...π— ..‚..Õ..π.. ...∑‘..∏...‘°..“..√..√..—∫...®..”..π..Õ...ß...
.μ..“..¡.. ...—≠...≠....“..®..”..π..Õ...ß..¥..ß—...°..≈..“à..«..„..À..·â...°..°à ..—π...‡.ª...ìπ..‡..¥..¥Á ...¢..“..¥..·...μ..«à..π—...π..’ȇ..ª..πì...μ..âπ...‰.ª....‚..¥..¬...‡.À..μ...∑ÿ ..º’Ë...Ÿâ‚.Õ...π..‰..¥...â.....................................·..≈...–..„.π...°..“..√..‚..Õ..π..π...¢È’ ..â“..æ...‡.®..“â..∑...È—ß.. ..Õ...ß..Ω...É“.¬.....
.®..–..‰.¥...â∫..Õ...°..°...≈..“à..«..°..“..√..‚..Õ..π...π..È’.„.À..ºâ...Ÿâ®..”..π..Õ...ß..∑...√..“..∫..‡..ª..πì...≈..“..¬..≈...°— ..…...≥...åÕ...—°..…...√..μ..àÕ...‰.ª......................................................................................................
......................∫...—π..∑...÷°..¢..Õâ...μ..°...≈..ß..π...’È∑..”..‰..«..âÀ..π...ß÷Ë ..©..∫...—∫....‡.°...∫Á ..‰..«..â .≥..... ...”.π...°—..ß..“..π...∑..Ë’¥...‘π....∑..ß—È... ..Õ..ß...Ω..“É..¬..‰..¥..μâ...√..«..®..¥...Ÿ∫..π—...∑..°÷...¢..âÕ..μ...°..≈...ß...·...≈..–..‡..¢..â“..„.®...¢..Õâ..§...«..“..¡........
μ...≈..Õ...¥..·...≈..«â....®..÷ß..≈...ß..≈..“..¬...¡..Õ◊...™..Õ◊Ë ..À...√..◊Õ..≈...ß..≈..“..¬...æ..¡‘...æ...πå ..«‘È..¡...◊Õ..‰.«...‡â .ª..ìπ...À..≈...—°..∞..“..π...μ..àÕ...À..π...â“..æ..¬...“..π..·...≈..–..‡..®..â“..æ..π...—°..ß..“..π...∑..Ë¥’...‘π....................................................

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............................................................................................≈..ß...™..◊ËÕ...........................................................π......“....¬.........¢......................................................º..â√Ÿ..∫—...®..”..π...Õ..ß..................................
............................................................................................≈..ß...™..◊ËÕ...........................................................π......“....¬.........§......................................................º..√Ÿâ..∫—...‚.Õ...π.......................................
............................................................................................≈..ß...™..◊ËÕ....................................................................................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..Ë◊Õ.....................................................................................................................................æ...¬..“..π...........................................
.............................∫...—π..∑...÷°..¢...Õâ ..μ...°..≈..ß..π...’ȉ..¥..∑â...”..μ..Õà...À..π...“â ......................................................................................................................................
............................................................................................≈..ß...™..◊ËÕ.....................................................................................................................................‡.®..“â..æ...π...°— ..ß..“..π..∑...¥Ë’..π‘..........................
..........................................................................................................ª..√..–..∑...∫—..μ...√..“..μ...”.·...À..π...ßà ..‡.ª...πì.. ...”..§..≠—..........................................................

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μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÒÙ

 “√∫—≠®¥∑–‡∫’¬π

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

«—π∑.Ë’ .................... ‚Õπ ∑‘ ∏‘°“√√∫— 𓬠¢. 𓬠§. Ò››››› › (≈ß™ËÕ◊ )........................
‡¥Õ◊ π................... ®”πÕß ºâ√Ÿ ∫— ®”πÕß º√⟠—∫‚Õπ
æ.». .....................

ÚÒı

ÚÒˆ

μ«— Õ¬à“ßÀ¡“¬‡≈¢ Òı (∑.¥. Ò)

(°√≥’‚Õπ‚¥¬¡’°ÆÀ¡“¬‡©æ“–„Àâ‚Õπ) ∑∫’Ë “â π
∑ Ë’ «π/‰√à

∑Ë’π“

∑Ë.’ .............

§”¢Õ®¥∑–‡∫’¬π ‘∑∏·‘ ≈–π‘μ‘°√√¡ πÕ°‡¢μ

·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑Ë’¥π‘ ª√–‡¿∑.‚.Õ...π.. ..‘∑...∏..‘°..“..√..√..—∫..®..”..π..Õ...ß..μ..“..¡..°...Æ..À¡“¬ „π‡¢μ

μ”·Àπàß∑’Ë¥‘π (μ“¡¡“μ√“............·Àßà æ√–√“™∫—≠≠μ— .‘ .........................)

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

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

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

‚©π¥∑Ë¥’ ‘π

‡≈¢∑Ë’............................................‡≈à¡........................................Àπ“â ....................................
®”π«π∑’¥Ë ‘π.................Ò..................‰√à................›.................ß“π................›...................μ“√“ß«“

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

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

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

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

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

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

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

Û. ¢“â 懮“â ...............°..√..¡....¢........................... ‡≈¢ª√–®”μ—«ª√–™“™π º.⟠..√..—∫...‚.Õ..π...........................

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

‚ ¥ À¡“â ¬ § àŸ ¡√ ™ÕË◊ ....................................................... —≠™“μ.‘ ......................
Õ¬∑àŸ ’∫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∑”π‘μ‘°√√¡π‡’È ªìπ‡ß‘π.............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢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) ‡..ª..πì..°...“.√..‚..Õ..π.. ...‘∑..∏..°‘..“..√..√..—∫...®..”..π..Õ..ß..μ...“.¡... ..≠—...≠...“..®..”..π...Õ..ß...©...∫..∫—..≈...ß..«..—π..∑..Ë.’ ..................................„.À..â·...°..°à ..√..¡........................................

μ...“.¡...¡..“..μ..√..“.........................................·..À..ßà..æ...√..–..√..“.™...∫..≠—...≠...μ—....‘ ...............................................................................................................................................
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«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™Õ◊Ë ......................°..√..¡....¢.........................ºŸâ¢Õ √—∫‚Õπ
≈ß™ËÕ◊ ..........................›............................ºâŸ¢Õ
≈ß™ËÕ◊ ......................................................º Ÿâ 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’.................................‡¥Õ◊ π............................................æ.»......................

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

μ«— Õ¬à“ßÀ¡“¬‡≈¢ Òı ÚÒ˜

(∑.¥. ˘)

§”¢Õ..‚..Õ..π... ..∑‘..∏...‘°..“..√..√..∫— ..®..”..π...Õ..ß..μ...“.¡...°..Æ...À..¡...“.¬......

(μ“¡¡“μ√“..................·Ààßæ√–√“™∫—≠≠—μ‘...................)

©∫—∫∑.’Ë ......................................

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

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

¢“â 懮â“...........................°..√..¡....¢................................................................. ‡≈¢ª√–®”μ—«ª√–™“™π

Õ“¬ÿ......Û.........ªï ‡™ÈÕ◊ ™“μ.‘ ..........‰.∑..¬............... ≠— ™“μ‘..........‰.∑...¬...............∫¥‘ “/¡“√¥“™◊ËÕ.....................................................................

Õ¬àŸ∑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¬◊πË §”¢ÕμÕà ‡®“â æπ—°ß“π∑¥’Ë ‘π®—ßÀ«—¥....................................................¥â«¬§«“¡ —쬮å √‘ß«“à :-

¢Õâ Ò. ¥â«¬....°..√..¡....°....‰.¥...â√..∫— ..®..”..π..Õ...ß..∑..¥’Ë..π‘...·..ª..≈...ß..‡.§..√..ËÕ◊...ß..À..¡..“..¬..¢...“â .ß...μ..âπ..‰..«.âμ...“..¡.. ..—≠....≠...“..®..”..π..Õ..ß....©..∫..∫—...≈..ß..«..π—..∑...Ë’ ............................∫...¥— ..π..’È
.‰.¥..â¡...°’ ..“..√..ª..√..∫—..ª...√..ÿß.. ..à«..π..√..“..™..°...“.√..‚..¥..¬..¬...°..‡.≈...‘°...°..√..¡....°......·..≈..–..®..¥—...μ..È—ß....°..√..¡....¢.....¢..÷Èπ..μ...“..¡..¡..“..μ..√..“.......................·..À...àß..æ..√..–..√..“..™..∫...≠— ...≠...—μ...‘............................................................................
.„.À..â‚..Õ..π..∑...√..—æ..¬..å ...‘π..´..ß÷Ë ..À...¡..“..¬..§..«..“..¡...√..«.¡...∂..÷ß.. ..‘∑...∏..‘°..“..√..√..∫— ..®..”..π...Õ..ß..¢..Õ..ß....°..√..¡....°.....¡...“.‡..ª..πì ...¢..Õ..ß...°...√..¡...¢....................................................................

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¢âÕ Ú. ©–ππ—È ¢Õ„À‡â ®“â æπ°— ß“π∑¥Ë’ π‘ .....®..¥..∑..–..‡..∫..¬’..π...‚.Õ..π... ..∑‘..∏...°‘ ..“..√..√..∫— ..®..”..π..Õ...ß..„.À..·â...°..à .°...√..¡...¢......μ..“..¡..°...Æ..À..¡...“.¬...¥..ß—..°..≈...à“..«...............

.„.À..ªâ...√..“.°...Ø..∑..“..ß..∑...–..‡.∫..¬’...π..¥..«â..¬...............................................................................................................................................................

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.......................°..√..¡....¢.......................... ºŸâ¢Õ
........................................................ 欓π
........................................................ 欓π

μ—«Õ¬à“ßÀ¡“¬‡≈¢ Òı ÚÒ¯

 “√∫—≠®¥∑–‡∫¬’ π

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

«π— ∑.’Ë .................... ‚Õπ ∑‘ ∏°‘ “√√∫— °√¡ °. °√¡ ¢. Ò››››› › (≈ß™Õ◊Ë )........................
‡¥◊Õπ................... ®”πÕßμ“¡°ÆÀ¡“¬ ºâ√Ÿ ∫— ®”πÕß º√Ÿâ ∫— ‚Õπ
æ.»...................... (μ“¡¡“μ√“...............

·Ààßæ√–√“™∫—≠≠μ— ‘
......................................)

μ«— Õ¬“à ßÀ¡“¬‡≈¢ Òˆ ÚÒ˘

(∑.¥. Ò)

∑∫’Ë “â π

∑’ Ë «π/‰√à

∑Ë’π“

∑.Ë’ .............

§”¢Õ®¥∑–‡∫’¬π ‘∑∏·‘ ≈–π‘μ‘°√√¡ πÕ°‡¢μ
·≈–°“√ Õ∫ «π ‘∑∏‘„π∑¥’Ë π‘ ª√–‡¿∑.‚.Õ...π.. ..‘∑...∏..°‘ ..“..√..√..∫— ..®..”..π..Õ...ß..∫..“..ß.. ..«à..π. „π‡¢μ

μ”·Àπàß∑Ë’¥‘π

∏𓧓√ °. ‚Õπ ‘∑∏‘°“√√—∫®”πÕß∫“ß à«π‡©æ“–¡Ÿ≈ÀπÈ’ à°Õ √â“ß‚§√ß°“√„Àâ·°à...............(≈ß™Ë◊Õπ‘ ‘μ∫ÿ§§≈‡©æ“–°‘®∑’Ë√—∫‚Õπ)√–«“ß......................................................................................... μ”∫≈.........................................................................................
à «π°“√ —√∫®”πÕ߇ ìªπª√– —°π„π Ÿ¡≈À È’π ◊ËÕπ§ß‡ ‘¥¡
‡≈¢∑’¥Ë ‘π..................................................................................... Õ”‡¿Õ........................................................................................
‡ â®“æ —π°ß“π Ë’∑ ‘¥π
Àπâ“ ”√«®..................................................................................®ß— À«—¥........................................................................................

‚©π¥∑Ë’¥‘π

‡≈¢∑’.Ë ...........................................‡≈¡à ........................................Àπ“â ....................................
®”π«π∑Ë¥’ π‘ .................Ò..................‰√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∫ππ’È ·≈–

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

Ú. ¢“â 懮“â ..............∏..π..“..§..“..√....°...................... ‡≈¢ª√–®”μ—«ª√–™“™π º.⟠..‚.Õ..π... ..∑‘..∏...°‘ ..“..√..√..∫— ..®..”..π..Õ...ß...

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

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

Õ¬à∑Ÿ ∫’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 ....................

Ò. (≈ß™Ë◊Õπ‘μ∫‘ §ÿ §≈‡©æ“–°‘®∑Ë√’ ∫— ‚Õπ) ‡≈¢ª√–®”μ—«ª√–™“™π º.Ÿâ ..√..—∫..‚..Õ..π.. ...‘∑..∏..‘°...“.√..√..—∫...®..”..π..Õ. ß
Û. ¢“â 懮â“.................................................

Ú.....∏..π...“..§..“..√...°...............................

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

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

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

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

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

ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à ( “¡ ∫‘ ≈“â π∫“∑∂«â π)

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

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

(Û) ∏...π..“..§..“..√...°......‚.Õ..π... ..∑‘..∏...‘°..“..√..√..—∫..®..”..π..Õ...ß..∫..“..ß.. ..«à..π..‡..©..æ...“.–..¡...≈Ÿ ..À..π...°È’ ..àÕ.. ...√..â“.ß..‚..§..√..ß..°..“..√....Û....,........,.........∫...“..∑...(.. ..“..¡.. ..‘∫...≈..“â..π......

∫...“..∑..∂..â«..π...)..μ...“.¡... ..—≠...≠....“.®..”..π...Õ..ß..‡.ª...πì ..ª..√..–..°...π— ...≈...ß..«..π— ..∑..’.Ë.............‡..¥..◊Õ..π.......................................æ....».................„.À...·â ..°..à...................................................(.≈..ß..™...◊ËÕ..π..μ‘...‘∫..§ÿ..§...≈..‡.©...æ..“..–..°..®‘..∑...’Ë√..—∫..‚.Õ...π..).

‚..¥..¬..‡..À..μ..∑ÿ...’∏Ë ..π..“..§..“..√....°.....º..âŸ.‚.Õ..π....‰.¥...â‚.Õ..π... ..‘∑..∏...‘‡.√..¬’ ..°..√..âÕ...ß..„.π..¡...≈Ÿ ..À..π...°’È ..Õà.. ...√..â“.ß..‚..§..√..ß..°..“..√..„..À..â·..°..à......................................................(..≈..ß..™..◊ËÕ..π...μ‘ ..‘∫...§ÿ ..§..≈...‡.©..æ...“..–..°..‘®..∑..√Ë’..∫—...‚.Õ..π...).

‰..ª..·..≈...â«... ..«à..π...°..“..√..√..—∫..®..”..π..Õ...ß..‡.ª..πì...ª..√..–..°..π—...¡..≈Ÿ..À...π..‡È’.ß..‘π...‡.∫..°‘...‡.°..‘π..∫...≠— ...™..·’..≈...–..´..Õ◊È..«..—μ...∂..¥ÿ..‘∫...∑..Ë¡’..’μ...Õà ..∏..π...“.§...“..√...°.....¬...—ß..§..ß..¡...’Õ..¬..àμŸ...“.¡...‡.¥..‘¡..............................

(Ù) „π°“√‚ÕππÈ’‰¥â√—∫¬°‡«πâ ‰¡μà Õâ ß∫Õ°°≈“à «°“√‚Õπ‰ª¬ß— ≈Ÿ°Àπ’È «π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................

∑ß—È πÈ’ μ“¡π¬— ¡“μ√“ Òı ·Ààßæ√–√“™°”Àπ¥πμ‘ ‘∫ÿ§§≈ ≈ß™◊ÕË ...................∏..π..“..§..“..√....°......................ºâŸ¢Õ ‚Õπ ‘∑∏‘°“√√∫— ®”πÕß
‡©æ“–°®‘ ‡æËÕ◊ °“√·ª≈ß ‘π∑√—æ¬å‡ªπì À≈°— ∑√æ— ¬å
≈ß™ËÕ◊ ............(.π..‘μ...‘∫..ÿ§..§...≈..‡.©...æ..“..–..°..‘®..).............ºŸâ¢Õ √—∫‚Õπ ‘∑∏‘°“√√—∫®”πÕß
æ.».ÚıÙ
≈ß™Õ◊Ë ......................................................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...............................................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™Õ◊Ë .......................................................

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

‡®â“æπ—°ß“π∑’Ë¥‘π

ÚÚ

μ—«Õ¬“à ßÀ¡“¬‡≈¢ Òˆ

(∑.¥. Òˆ)

∫π— ∑°÷ ¢âÕμ°≈ß‚Õπ ‘∑∏°‘ “√√—∫®”πÕß∫“ß à«π

∑’Ë¥‘π
√–«“ß...............................................................................μ”∫≈........................................................................
‡≈¢∑Ë’¥π‘ ...............................Àπ“â  ”√«®............................Õ”‡¿Õ.......................................................................
‚©π¥À¡“¬‡≈¢∑.’Ë ..............................................................®—ßÀ«¥— .......................................................................
∑Ë’«“à °“√.....................................................................

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

¢“â 懮“â ...∏...π..“..§..“..√...°...............................º..Ÿâ‚..Õ..π.. ...‘∑..∏..‘°..“..√..√..—∫..®...”.π...Õ..ß................. ‡≈¢ª√–®”μ—«ª√–™“™π

...(..≈..ß..™..ËÕ◊..π...μ‘ ..‘∫...ÿ§..§..≈...‡.©..æ...“..–..°..®‘ ..).....º..√âŸ..∫—...‚.Õ..π... ..∑‘ ..∏..°‘...“.√..√..∫—...®..”..π..Õ..ß.............

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

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

μ”∫≈/·¢«ß...............................Õ”‡¿Õ/‡¢μ...............................®—ßÀ«¥— ................................À¡“¬‡≈¢‚∑√»æ— ∑å..............................
¢//Õ//ª//Ø//‘≠//“/≥///μ//π//·/≈//–//„/À//∂â //Õâ //¬/§//”//μ/Õà//.....‰..¥..â∑...”.∫...π— ..∑..°÷...¢..âÕ..μ...°..≈..ß..μ..àÕ...‡.®..â“..æ..π...—°..ß..“..π..∑...’Ë¥..π‘.....................................................................................

¥//«â//¬//§//«/“/¡// //—μ//¬//®å /√//‘ß/ ¥—ßμÕà ‰ªπÈ’ :›
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μ—«Õ¬à“ßÀ¡“¬‡≈¢ Òˆ

 “√∫—≠®¥∑–‡∫’¬π

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

«—π∑.Ë’ .................... ®”πÕ߇ªπì ª√–°—π ∫√…‘ ∑— ‡Õ. ∏𓧓√ °. ı››››› › (≈ß™◊ËÕ)........................
‡¥Õ◊ π................... º√Ÿâ ∫— ®”πÕß
æ.». .....................

«π— ∑Ë’..................... ‚Õπ ∑‘ ∏°‘ “√√∫— ∏𓧓√ °. Ò. (≈ß™◊ÕË πμ‘ ∫‘ §ÿ §≈ ı › › › › › › (≈ß™◊ËÕ)........................

‡¥Õ◊ π................... ®”πÕß∫“ß à«π º√Ÿâ ∫— ®”πÕß ‡©æ“–°‘®∑Ë√’ ∫— ‚Õπ ∏𓧓√ °. ‚Õπ ‘∑∏°‘ “√√—∫®”πÕß∫“ß à«π

æ.». ..................... º√Ÿâ ∫— ‚Õπ ‡©æ“–¡Ÿ≈Àπ°È’ Õà  √â“ß‚§√ß°“√„À·â °à (≈ß™ÕË◊
Ú. ∏𓧓√ °. πμ‘ ∫‘ §ÿ §≈‡©æ“–°®‘ ∑√Ë’ ∫— ‚Õπ)  à«π°“√√—∫®”πÕß

‡ªìπª√–°—π„π¡≈Ÿ ÀπÈÕ’ Ë◊π§ß‡¥‘¡
ºâ√Ÿ —∫®”πÕß

ÚÚÒ

ÚÚÚ

μ«— Õ¬à“ßÀ¡“¬‡≈¢ Ò˜ (∑.¥. Ò)

∑∫’Ë “â π

∑ Ë’ «π/‰√à

∑’Ëπ“

∑.’Ë .............

§”¢Õ®¥∑–‡∫¬’ π ‘∑∏·‘ ≈–πμ‘ °‘ √√¡ πÕ°‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑Ë¥’ ‘π ª√–‡¿∑.‚.Õ...π.. ..∑‘...∏..°‘ ..“..√..√..—∫..®..”..π..Õ...ß..∫..“..ß..√..“..¬. „π‡¢μ

μ”·Àπàß∑Ë’¥‘π

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

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

∏𓧓√ °. ‚Õπ ‘∑ ‘∏°“√√—∫®”πÕß„π à«π¢Õßμπ„Àâ·°à (≈ß™◊ËÕ ‘π ‘μ ÿ∫§§≈‡©æ“–°‘®∑Ë’√—∫‚Õπ)  à«π°“√®”πÕß∑’Ë ’¡μàÕ âŸº√—∫®”πÕß√“¬Õ◊Ëπ§ß‡¥‘¡ Àπâ“ ”√«®..................................................................................®—ßÀ«¥— ........................................................................................
‡®â“æπ—°ß“π ’Ë∑ ‘¥π
‚©π¥∑¥Ë’ π‘

‡≈¢∑.’Ë ...........................................‡≈¡à ........................................Àπ“â ....................................
®”π«π∑’¥Ë ‘π.................Ò..................‰√.à ...............›.................ß“π................›...................μ“√“ß«“

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

‰¥ªâ Ø‘≠“≥μπ·≈â« ¢Õ„Àâ∂âÕ¬§”¥«â ¬§«“¡ —μ¬å®√‘ß ∂“â ¢â“懮“â „Àâ∂âÕ¬§”‰¡à‡ªì𧫓¡®√ß‘ „Àâ„™∂â âÕ¬§”π’Ȭ—π¢“â 懮Ⓞπ∑“ߧ¥’Õ“≠“‰¥â

Ú. ¢“â 懮“â ..............Ò.....∏..π...“.§...“..√...°.................. ‡≈¢ª√–®”μ—«ª√–™“™π ºâ.Ÿ ..‚.Õ..π... ..∑‘..∏...°‘ ..“..√..√..—∫..®..”..π..Õ...ß...

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

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

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.....................

Ò. (≈ß™◊ËÕπμ‘ ∫‘ ÿ§§≈‡©æ“–°®‘ ∑’Ë√∫— ‚Õπ) ‡≈¢ª√–®”μ—«ª√–™“™π º.Ÿâ ..√..—∫..‚..Õ..π.. ...‘∑..∏..‘°...“.√..√..—∫...®..”..π..Õ. ß
Û. ¢â“懮“â .................................................

................................................

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

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

Õ¬à∑Ÿ 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“â ¢Õ· ¥ß√“§“∑√—æ¬å∑’¢Ë Õ∑”πμ‘ °‘ √√¡π’‡È ªπì ‡ßπ‘ .....................Û....,........,........................∫“∑.........›........... μ“ߧå

ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à ( “¡ ∫‘ ≈“â π∫“∑∂«â π)

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

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

(Û) .‡.ª..πì...°..“..√..‚.Õ..π... ..∑‘..∏...°‘ ..“..√..√..—∫..®..”..π..Õ...ß..‡.©..æ...“..–.. ..«à ..π..¢..Õ...ß..∏..π..“..§..“..√....°....„.π...¡..Ÿ≈..À...π..’È®..”..π..«..π....Û.....,.......,..........∫..“..∑....μ..“..¡.. ...≠— ...≠...“.......
®..”..π..Õ...ß...≈..ß..«..—π...∑..’.Ë.............‡.¥...◊Õ..π.......................................æ....»......................„.À...·â ..°..à.................................(..≈..ß..™..◊ÕË..π...μ‘ ..∫‘...§ÿ ..§..≈...‡.©..æ...“.–...°..®‘ ..∑..√’Ë..—∫...‚.Õ..π...)..‚..¥..¬..‡..À..μ..ÿ∑...˺’ ..⟂.Õ...π..‰.¥...â‚.Õ...π.. ..∑‘...∏..‘‡.√..’¬..°..√..âÕ...ß..
‡.©...æ..“..–.. ..«à..π...¢..Õ..ß..μ..π...„.π..¡...Ÿ≈..À..π...’È .Û.....,........,.........∫..“..∑....„.À...·â ..°...à.........................(..≈..ß..™..ËÕ◊...π..‘μ..‘∫...§ÿ ..§..≈...‡.©..æ...“..–..°..®‘ ..∑..√Ë’..∫—...‚.Õ..π...)..‰..ª..·..≈...«â ... ..”..À...√..∫— ..°..“..√..√..∫—..®..”..π...Õ..ß..

„.π... ..à«..π..¢..Õ...ß..º..âŸÕ..πË◊...§..ß..‡.¥...‘¡.....................................................................................................................................................................

(Ù) „π°“√‚Õππ’ȉ¥√â —∫¬°‡«âπ‰¡àμÕâ ß∫Õ°°≈à“«°“√‚Õπ‰ª¬ß— ≈Ÿ°ÀπÈ’ «π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................

∑Èß— πÈ’ μ“¡π¬— ¡“μ√“ Òı ·Ààßæ√–√“™°”Àπ¥π‘μ∫‘ ÿ§§≈ ≈ß™Õ◊Ë ...................∏..π..“..§..“..√....°......................ºâŸ¢Õ ‚Õπ ∑‘ ∏°‘ “√√∫— ®”πÕß

‡©æ“–°‘® ‡æË◊Õ°“√·ª≈ß π‘ ∑√æ— ¬‡å ªπì À≈°— ∑√—æ¬å ≈ß™ÕË◊ ............(.π..‘μ...‘∫..§ÿ..§...≈..‡.©...æ..“..–..°..®‘..).............ºâŸ¢Õ √—∫‚Õπ ‘∑∏‘°“√√—∫®”πÕß

æ.».ÚıÙ ≈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™◊ÕË .......................................................

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

‡®â“æπ—°ß“π∑’Ë¥‘π

μ—«Õ¬“à ßÀ¡“¬‡≈¢ Ò˜ ÚÚÛ

(∑.¥. Òˆ)

∫π— ∑÷°¢âÕμ°≈ß‚Õπ ∑‘ ∏°‘ “√√∫— ®”πÕß∫“ß√“¬

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

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

¢“â 懮“â ...∏..π...“..§..“..√...°...............................º..Ÿâ‚..Õ..π.. ...∑‘ ..∏..‘°..“..√..√..—∫..®...”.π...Õ..ß................. ‡≈¢ª√–®”μ—«ª√–™“™π

...(..≈..ß..™..ÕË◊..π...‘μ..‘∫...ÿ§..§..≈...‡.©..æ...“.–...°..‘®..).....º..√Ÿâ..∫—..‚..Õ..π.. ...∑‘ ..∏..°‘...“.√..√..∫—...®..”..π..Õ..ß.............

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

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

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

 “√∫≠— ®¥∑–‡∫¬’ π

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

«—π∑.Ë’ .................... ®”πÕ߇ªìπª√–°π— ∫√…‘ —∑ ‡Õ. Ò. ∏𓧓√ °. ı › › › › › › (≈ß™Õ◊Ë )........................
‡¥◊Õπ................... Ú. ∏𓧓√ ¢.
æ.». ..................... Û. ∏𓧓√ §.

ºâŸ√∫— ®”πÕß

«π— ∑Ë’..................... ‚Õπ ∑‘ ∏°‘ “√√∫— Ò. ∏𓧓√ °. Ò. (≈ß™◊ÕË πμ‘ ∫‘ §ÿ §≈ ı › › › › › › (≈ß™ËÕ◊ )........................
‡¥◊Õπ................... ®”πÕß∫“ß√“¬
æ.». ..................... Ú. ∏𓧓√ ¢. ‡©æ“–°®‘ ∑√Ë’ —∫‚Õπ ∏𓧓√ °. ‚Õπ ∑‘ ∏°‘ “√√∫— ®”πÕß„π «à π

Û. ∏𓧓√ §. º√⟠∫— ‚Õπ ¢Õßμπ„À·â °à (≈ß™◊ÕË πμ‘ ∫‘ ÿ§§‡©æ“–°®‘

ºâ√Ÿ ∫— ®”πÕß Ú. ∏𓧓√ ¢. ∑√Ë’ ∫— ‚Õπ)  «à π°“√®”πÕß∑’¡Ë μ’ àÕºŸ√â —∫®”πÕß

Û. ∏𓧓√ §. √“¬ÕË◊π§ß‡¥‘¡

º√Ÿâ ∫— ®”πÕß

μ«— Õ¬à“ßÀ¡“¬‡≈¢ Ò¯ ÚÚı

(∑.¥. Ò)

∑∫’Ë “â π

∑ Ë’ «π/‰√à

∑’Ëπ“

∑.’Ë .............

§”¢Õ®¥∑–‡∫¬’ π ∑‘ ∏·‘ ≈–π‘μ‘°√√¡ πÕ°‡¢μ
·≈–°“√ Õ∫ «π ‘∑∏‘„π∑¥’Ë π‘ ª√–‡¿∑...√..–..ß..∫—...®..”..π..Õ..ß....(.ª..≈...¥..®..”..π..Õ...ß..)... „π‡¢μ

μ”·Àπàß∑’Ë¥‘π

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

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

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

‚©π¥∑¥’Ë ‘π

‡≈¢∑.Ë’ ...........................................‡≈¡à ........................................Àπâ“....................................
®”π«π∑Ë¥’ ‘π.................Ò..................‰√.à ...............›.................ß“π................›...................μ“√“ß«“

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

‰¥âªØ‘≠“≥μπ·≈«â ¢Õ„À∂â Õâ ¬§”¥«â ¬§«“¡ —μ¬å®√ß‘ ∂“â ¢“â 懮ⓄÀ∂â âÕ¬§”‰¡‡à ªì𧫓¡®√ß‘ „Àâ„™â∂âÕ¬§”πÈ’¬π— ¢“â 懮“â „π∑“ߧ¥Õ’ “≠“‰¥â

Ú. ¢“â 懮“â ..............π..“..¬...¢............................. ‡≈¢ª√–®”μ—«ª√–™“™π º.Ÿâ ..√..∫— ..®..”..π..Õ...ß......................

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

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

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 ....................

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

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

‚ ¥ À¡“â ¬ § Ÿà ¡√ ™◊ËÕ....................................................... —≠™“μ.‘ ......................
Õ¬àŸ∑∫’Ë “â π/À¡Ÿ∫à 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 ªìπ‡ßπ‘ .............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à

(Ò) ¢â“懮“â ‰¡à‰¥â√∫— ‚Õπ·∑πÀ√◊Õ‡æÕË◊ ª√–‚¬™πå·°à∫ÿ§§≈μ“à ߥ“â «
(Ú) √“§“∑√æ— ¬∑å Ë’· ¥ß‰«â„π Ù. ‡ªπì √“§“∑Ë’·∑®â √ß‘
(Û) ‡.ª...ìπ..°..“..√..ª..≈...¥..®..”..π..Õ...ß..μ..“..¡.. ...≠— ...≠...“..®..”..π..Õ..ß....≈..ß..«..—π...∑..Ë’ .............‡..¥..◊Õ..π......................................æ...»....................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................

«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
≈ß™ÕË◊ ......................π..“..¬....¢.........................ºâŸ¢Õ √—∫®”πÕß
≈ß™ËÕ◊ ......................π..“..¬....°.........................ºŸâ¢Õ ®”πÕß
≈ß™ÕË◊ ......................................................º âŸ Õ∫ «π

(......................................................)
 ”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‘ ...............................................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«·μ«à π— ∑Ë’.................................‡¥Õ◊ π............................................æ.»......................

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

ÚÚˆ

μ«— Õ¬“à ßÀ¡“¬‡≈¢ Ò¯

(∑.¥. Òˆ)

∫—π∑°÷ ¢Õâ μ°≈ß√–ß∫— ®”πÕß (ª≈¥®”πÕß)

∑’Ë¥‘π
√–«“ß...............................................................................μ”∫≈........................................................................
‡≈¢∑¥’Ë ‘π...............................Àπ“â  ”√«®............................Õ”‡¿Õ.......................................................................
‚©π¥À¡“¬‡≈¢∑.Ë’ ..............................................................®—ßÀ«¥— .......................................................................
∑’Ë«à“°“√.....................................................................

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

¢“â 懮“â .....................π..“..¬....¢......º..√Ÿâ..—∫..®..”..π...Õ..ß................................................ ‡≈¢ª√–®”μ—«ª√–™“™π

.....................π..“..¬....°.......º..®âŸ ..”..π..Õ...ß....................................................

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

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

μ”∫≈/·¢«ß...............................Õ”‡¿Õ/‡¢μ...............................®—ßÀ«—¥................................À¡“¬‡≈¢‚∑√»—æ∑.å .............................
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¥//«â//¬//§//«/“/¡// //—μ//¬//®å /√//ß‘ / ¥—ßμÕà ‰ªπÈ’ :›
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μ«— Õ¬à“ßÀ¡“¬‡≈¢ Ò¯

 “√∫≠— ®¥∑–‡∫¬’ π

®¥∑–‡∫¬’ π ª√–‡¿∑°“√ ºŸâ„À â ≠— ≠“ ºâŸ√—∫ —≠≠“ ‡πÈ◊Õ∑’Ë¥‘π ‡π◊ÈÕ∑’Ë¥‘π √–«“ß ‡®â“æπ—°ß“π∑’Ë¥‘π
«—𠇥Õ◊ π ªï ®¥∑–‡∫’¬π μ“¡ ≠— ≠“ §ß‡À≈Õ◊ ‡≈¢∑Ë’¥‘π ≈ß≈“¬¡Õ◊ ™Õ◊Ë
𓬠¢. 𓬠°. ‚©π¥∑¥’Ë π‘ „À¡à ª√–∑∫— μ√“
«—π∑.Ë’ .................... √–ß∫— ®”πÕß º√⟠∫— ®”πÕß ‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
‡¥Õ◊ π................... (ª≈¥®”πÕß) «“ «“
æ.». .....................
Ò››››› › (≈ß™Ë◊Õ)........................

ÚÚ˜

ÚÚ¯

μ«— Õ¬“à ßÀ¡“¬‡≈¢ Ò˘ (∑.¥. Ò)
∑∫Ë’ “â π

∑’Ë «π/‰√à

∑’Ëπ“

∑Ë.’ .............

§”¢Õ®¥∑–‡∫’¬π ‘∑∏·‘ ≈–π‘μ‘°√√¡ πÕ°‡¢μ

„π‡¢μ

·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑Ë¥’ ‘π ª√–‡¿∑.√..–...ß..∫— ..®..”..π..Õ...ß...(.»...“.≈...¢..“..¬..∫..ß—..§...∫— ..®. ”πÕß)

μ”·Àπàß∑’Ë¥‘π

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

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

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

‚©π¥∑¥’Ë ‘π

‡≈¢∑.’Ë ...........................................‡≈à¡........................................Àπ“â ....................................
®”π«π∑¥’Ë π‘ .................Ò..................‰√à................›.................ß“π................›...................μ“√“ß«“

Ò. ¢â“æ‡®â“ºâŸ¡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„Àâ∂âÕ¬§”¥â«¬§«“¡ μ— ¬å®√ß‘ ∂â“¢â“懮“â „Àâ∂Õâ ¬§”‰¡à‡ªπì §«“¡®√‘ß„Àâ„™â∂Õâ ¬§”π’È¬π— ¢â“懮“â „π∑“ߧ¥Õ’ “≠“‰¥â

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

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

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

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

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

Û. ¢“â 懮“â ...............π..“..¬....°........................... ‡≈¢ª√–®”μ—«ª√–™“™π º.⟠..®..”..π..Õ...ß..........................

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

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

Õ¬Ÿà∑’∫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.....................

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

ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à

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

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

(Û) ∑..Ë’¥...π‘ ..·..ª...≈..ß..π..È»’...“.≈...‰.¥..¢â...“.¬...∑..Õ..¥...μ..≈..“..¥...Õ..π—..‡..π..◊ÕË..ß..¡...“.·...μ..à°..“..√..∫...ß— ..§..—∫..®..”..π...Õ..ß..μ..“..¡... ..≠— ...≠...“..®..”..π..Õ...ß...≈..ß..«..π—...∑..Ë’.........‡..¥..◊Õ..π..................

æ...»....................°..“..√..®..”..π..Õ..ß..®...ß÷ ..√..–..ß..∫— .. ..‘Èπ...‰.ª..μ...“..¡..¡..“..μ...√.“....˜...Ù..Ù....(.ı..)...·..À...àß...ª...æ...æ.............................................................

(Ù) ¢..“â..æ..‡..®..“â ...π..“..¬....§....‡..ª..πì..º...Ÿ´â ..ÕÈ◊ ..‰..¥..®â..“..°..°..“..√..¢..“..¬..∑...Õ..¥..μ...≈..“..¥..¢...Õ..ß..»..“..≈..μ...“..¡..À..π...ß— .. ..◊Õ.. ...”.π...°— ..ß..“..π..∫...—ß..§..—∫..§...¥..’.......................................

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

≈ß™ÕË◊ ......................π..“..¬...§..........................ºŸâ¢Õ √—∫®”πÕß

≈ß™◊ËÕ......................................................ºŸâ¢Õ ®”πÕß

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

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

‡®â“æπ—°ß“π∑’Ë¥‘π

μ«— Õ¬“à ßÀ¡“¬‡≈¢ Ò˘ ÚÚ˘

(∑.¥. ˘)

§”¢Õ..√...–..ß..∫— ..®..”..π...Õ..ß....(.»..“..≈..¢...“..¬..∫..—ß..§...∫— ..®..”..π...Õ..ß..)...

©∫—∫∑.Ë’ ......................................

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

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

¢â“懮â“...........................π..“..¬....§................................................................. ‡≈¢ª√–®”μ—«ª√–™“™π

Õ“¬.ÿ .....Û.........ªï ‡™◊ÈÕ™“μ‘...........‰.∑..¬............... —≠™“μ.‘ .........‰.∑...¬...............∫¥‘ “/¡“√¥“™Õ◊Ë .....................................................................

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

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

¢Õ¬◊Ëπ§”¢ÕμàÕ‡®â“æπ—°ß“π∑Ë’¥‘π®—ßÀ«¥— ....................................................¥«â ¬§«“¡ μ— ¬å®√‘ß«“à :-
¢âÕ Ò. ¥â«¬..∑..¥Ë’...π‘ ..·..ª...≈..ß..‡.§...√..◊ÕË ..ß..À...¡..“..¬..¥..ß—..°...≈..à“..«..¢..â“..ß..∫..π..π...È’ .¡...™’ ..ÕË◊ ....π..“..¬...°.....‡.ª..ìπ...º..â∂Ÿ..Õ◊...°..√..√..¡.. ...∑‘ ..∏..‘Ï.π...“..¬...°.....‰.¥..â®...”.π...Õ..ß..‰.«..°â...—∫..π..“..¬....¢..

.μ..“..¡.. ..—≠....≠...“..®..”..π..Õ..ß....≈..ß..«..—π..∑...Ë’....................‡..¥..Õ◊..π................................................................æ....»..............................∫...¥— ..π..È’..»..“..≈..........................................‰..¥..¢â..“..¬..∑...Õ..¥..μ...≈..“..¥..Õ...—π..‡.π...ËÕ◊ ..ß..¡..“..·..μ...°à ..“..√..∫..—ß..§...—∫..
.®..”.π...Õ..ß..√..“..¬..π..È’..μ..“..¡..§...¥..À’...¡..“..¬..‡.≈...¢..·..¥..ß..∑...Ë’.................................°..“..√..®..”..π..Õ..ß...®..÷ß..√..–..ß..—∫.. ..‘Èπ...‰.ª..μ...“..¡..¡..“..μ...√..“...˜...Ù..Ù....(.ı..)...·..À...àß...ª....æ....æ......·..≈...–..¢..â“..æ..‡.®...â“...π..“..¬....§..........
.‡.ª..πì...º..´âŸ ..◊ÕÈ..‰..¥..â®..“..°..°..“..√..¢..“..¬...∑..Õ..¥...μ..≈..“..¥...μ..“..¡..À..π...ß— .. ..◊Õ.. ...”..π..°— ..ß..“..π..∫...ß— ..§..∫—...§..¥..’.................................∑...Ë’........................≈..ß..«..—π...∑..’.Ë....................‡.¥...◊Õ..π......................................................æ.....».................................

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¢âÕ Ú. ©–ππ—È ¢Õ„À‡â ®“â æπ°— ß“π∑¥Ë’ π‘ ..¥..”..‡.π...‘π..°..“..√..®..¥...∑..–..‡.∫...’¬..π..√..–..ß..—∫...®..”..π..Õ..ß....(.»...“.≈...¢..“..¬..√..–..ß..—∫..®...”.π...Õ..ß..)...„.À..ªâ...√..“..°..Ø..„..π..‚.©...π..¥..∑...¥’Ë ..‘π.

.·..ª..≈..ß..π...¥È’ ..«â..¬.....................................................................................................................................................................................

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À¡“¬‡Àμÿ °√≥’´ÕÈ◊ ®“°°“√¢“¬∑Õ¥μ≈“¥ ºŸâ¢Õ®–μÕâ ߬Ë◊π§”¢Õ¢“¬ .......................π..“..¬....§.......................... ºŸâ¢Õ
μ“¡§” ß—Ë »“≈ æ√âÕ¡°—∫§”¢Õ√–ß∫— ®”πÕß (»“≈¢“¬∫—ߧ∫— ®”πÕß) π’È ........................................................ 欓π
‡æ◊ÕË „Àªâ √“°Ø™ËÕ◊ ºŸ´â ÕÈ◊ ®“°°“√¢“¬∑Õ¥μ≈“¥ ........................................................ 欓π

μ—«Õ¬“à ßÀ¡“¬‡≈¢ Ò˘ ÚÛ

 “√∫—≠®¥∑–‡∫¬’ π

®¥∑–‡∫’¬π ª√–‡¿∑°“√ ºâŸ„À â ≠— ≠“ ºâŸ√—∫ —≠≠“ ‡π◊ÈÕ∑’Ë¥‘π ‡πÈ◊Õ∑Ë’¥‘π √–«“ß ‡®â“æπ—°ß“π∑Ë’¥‘π
«—𠇥Õ◊ π ªï ®¥∑–‡∫’¬π μ“¡ —≠≠“ §ß‡À≈Õ◊ ‡≈¢∑Ë’¥‘π ≈ß≈“¬¡Õ◊ ™ÕË◊
𓬠¢. 𓬠°. ‚©π¥∑Ë¥’ ‘π„À¡à ª√–∑∫— μ√“
«—π∑Ë’..................... √–ß∫— ®”πÕß ºâ√Ÿ ∫— ®”πÕß ‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
‡¥Õ◊ π................... (»“≈¢“¬∫ß— §∫— «“ «“
æ.»...................... ®”πÕß)
Ò››››› › (≈ß™◊ËÕ)........................

«π— ∑’Ë..................... ¢“¬μ“¡§” Ëß— »“≈ 𓬠°. 𓬠§. Ò››››› › (≈ß™ÕË◊ )........................
‡¥◊Õπ...................
æ.». .....................

À¡“¬‡Àμÿ °“√®¥∑–‡∫¬’ π√–ß∫— ®”πÕß (»“≈¢“¬∫ß— §—∫®”πÕß) ®–μÕâ ß¡°’ “√¬◊πË §”¢Õ·≈–®¥∑–‡∫’¬π
ª√–‡¿∑μ“¡§” ßË— »“≈ ‰ªæ√Õâ ¡°π— ‡æÕË◊ „Àªâ √“°Ø™ÕË◊ ºâ´Ÿ È◊Õ‰¥®â “°°“√¢“¬∑Õ¥μ≈“¥

ÚÛÒ

μ—«Õ¬“à ßÀ¡“¬‡≈¢ Ú (∑.¥. Ò)
∑∫’Ë “â π

∑ ’Ë «π/‰√à

∑’Ëπ“

∑Ë’..............

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

„π‡¢μ

·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑Ë’¥‘π ª√–‡¿∑.√..–..ß..∫—...®..”..π..Õ..ß....(.À...π..È’‡.°..≈...◊ÕË ..π..°...≈..◊π..°. π— )

μ”·Àπàß∑Ë’¥‘π

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

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

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

‚©π¥∑Ë’¥‘π

‡≈¢∑Ë.’ ...........................................‡≈¡à ........................................Àπâ“....................................
®”π«π∑’¥Ë ‘π.................Ò..................‰√à................›.................ß“π................›...................μ“√“ß«“

Ò. ¢â“懮“â º¡âŸ π’ “¡μÕà ‰ªπÈ’ ¡’§«“¡ª√– ß§å¢Õ®¥∑–‡∫¬’ π ‘∑∏‘·≈–πμ‘ °‘ √√¡‡°Ë¬’ «°∫— Õ ß— À“√¡‘ ∑√æ— ¬∑å ’Ë°≈à“«¢â“ß∫ππ’È ·≈–

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

Ú. ¢“â 懮â“..............π..“..¬...¢............................. ‡≈¢ª√–®”μ—«ª√–™“™π º.Ÿâ ..√..—∫..®..”..π..Õ...ß......................

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

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

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

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

‚ ¥ À¡“â ¬ § Ÿà ¡√ ™Ë◊Õ....................................................... ≠— ™“μ.‘ ......................
Õ¬Ÿà∑Ë∫’ “â π/À¡àŸ∫“â π..........................‡≈¢∑.Ë’ ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡Ÿ∑à ’.Ë .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«—¥.................................À¡“¬‡≈¢‚∑√»—æ∑.å ....................

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

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

(Ú) √“§“∑√æ— ¬å∑Ë·’  ¥ß‰«â„π Ù. ‡ªìπ√“§“∑’Ë·∑â®√‘ß
(Û) ¢..“â..æ...‡.®..“â..º..Ÿ√â..—∫...®..”..π..Õ..ß..μ...“.¡... ..—≠...≠...“..®..”..π...Õ..ß...≈...ß..«..π— ..∑..’.Ë ...........‡.¥...◊Õ..π..............................æ...»....................´..◊ÈÕ..∑...’Ë¥..π‘ ..·..ª...≈..ß..π...È’ .................

‰..¥..®â..“..°..°..“..√..¢..“..¬..∑...Õ..¥..μ...≈..“..¥..¢...Õ..ß..»..“..≈..μ...“..¡..À..π...—ß.. ..Õ◊.. ...”.π...°— ..ß..“..π..∫...—ß..§..—∫..§...¥...’.........................................................∑..’.Ë.......................................................................
≈...ß..«.—π...∑..Ë’.....................‡.¥...◊Õ..π.................................................æ.....».................................................................................................................................

«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™ËÕ◊ ......................π..“..¬....¢.........................ºâŸ¢Õ √—∫®”πÕß
≈ß™Ë◊Õ......................π..“..¬....¢.........................ºŸâ¢Õ √—∫‚Õπ
≈ß™ËÕ◊ ......................................................º âŸ Õ∫ «π

(......................................................)
 ”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 ......................................................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◊ .......................................................
(......................................................)
‡®â“æπ—°ß“π∑’Ë¥‘π

ÚÛÚ

μ«— Õ¬“à ßÀ¡“¬‡≈¢ Ú

(∑.¥. ˘)

§”¢Õ..√..–...ß..∫— ..®..”..π...Õ..ß....(.À..π...‡È’ .°..≈...ÕË◊ ..π..°...≈..π◊...°..—π..).........

©∫—∫∑.Ë’ ......................................

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

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

¢â“懮“â ...........................π..“..¬....¢................................................................. ‡≈¢ª√–®”μ—«ª√–™“™π

Õ“¬ÿ......Û.........ªï ‡™Õ◊È ™“μ‘...........‰.∑..¬............... ≠— ™“μ.‘ .........‰.∑...¬...............∫‘¥“/¡“√¥“™◊ÕË .....................................................................

Õ¬Ÿ∑à 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 ......................

¢Õ¬◊Ëπ§”¢ÕμÕà ‡®â“æπ—°ß“π∑¥’Ë π‘ ®—ßÀ«—¥....................................................¥â«¬§«“¡ —쬮å √‘ß«à“ :-
¢âÕ Ò. ¥â«¬...∑...Ë¥’ ..π‘...·..ª..≈..ß..‡..§..√..ËÕ◊..ß..À...¡..“..¬..¢..“â..ß..∫...π..π..’È..¢..“â..æ..‡..®..“â ...π..“..¬....¢.....‰.¥...√â ..∫— ..®..”..π..Õ...ß..‰.«..â®..“..°....π..“..¬....°.....μ..“..¡... ..≠— ...≠...“..®..”..π..Õ...ß............................

.≈..ß..«..π— ..∑..’.Ë...............................‡.¥..Õ◊...π............................................................æ....».....................................∫...¥— ..π..’È..¢..â“..æ..‡.®...“â ...π..“..¬....¢.....º..√âŸ..—∫...®..”..π..Õ..ß..‰..¥..â´..Õ◊È...∑..Ë’¥..π‘...·..ª..≈..ß...π..’È .‰..¥..®â..“..°..°..“..√..¢..“..¬..∑...Õ..¥...μ..≈..“..¥...
¢...Õ..ß..»..“..≈..............................................§..¥...’À..¡...“.¬...‡.≈..¢..·...¥..ß..∑..Ë’.................................μ...“..¡..À..π...—ß.. ..◊Õ.. ...”.π...°— ..ß..“..π..∫...ß— ..§..—∫..§...¥..’.......................................≈..ß..«..—π..∑...Ë’.................‡.¥...Õ◊ ..π..........................................æ.....»........................
°...“..√..®..”.π...Õ..ß..μ...“.¡... ..≠—...≠...“..®..”..π..Õ...ß..¥..—ß..°...≈..à“..«..®..ß÷ ..√..–..ß..∫— .. ..‘πÈ...‰.ª...¥..«â..¬..‡.À...μ..ÿÀ...π..’ȇ.°..≈...◊ËÕ..π..°...≈..π◊ ..°..—π..................................................................................

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¢âÕ Ú. ©–ππÈ— ¢Õ„À‡â ®“â æπ°— ß“π∑¥’Ë π‘ ...¥...”.‡..π..π‘..°...“.√..®..¥...∑..–..‡..∫..’¬..π...√..–..ß..—∫..®..”..π..Õ...ß...(.À...π..‡È’.°...≈..◊ÕË..π...°..≈..◊π...°..π— ..)...„.À...âª..√..“..°..Ø..„..π..‚.©...π..¥..∑...Ë’¥..‘π.....

·...ª..≈..ß..π...’È¥..â«..¬.....................................................................................................................................................................................

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À¡“¬‡Àμÿ °√≥´’ Õ◊È ®“°°“√¢“¬∑Õ¥μ≈“¥ °√≥’π’È ºŸ¢â Õ®–μâÕß .......................π..“..¬....¢.......................... ºâŸ¢Õ
¬πË◊ §”¢Õ¢“¬μ“¡§” —Ëß»“≈æ√Õâ ¡°—∫§”¢Õ√–ß∫— ®”πÕß ........................................................ 欓π
(Àπȇ’ °≈Ë◊Õπ°≈◊π°—π) ‡æ◊ËÕ„Àâª√“°Ø™◊ÕË ºâ´Ÿ ÈÕ◊ ®“°°“√¢“¬∑Õ¥μ≈“¥°àÕπ ........................................................ 欓π

μ«— Õ¬“à ßÀ¡“¬‡≈¢ Ú

 “√∫≠— ®¥∑–‡∫’¬π

®¥∑–‡∫’¬π ª√–‡¿∑°“√ ºŸâ„À â ≠— ≠“ ºâŸ√—∫ —≠≠“ ‡π◊ÈÕ∑’Ë¥‘π ‡π◊ÈÕ∑Ë’¥‘π √–«“ß ‡®â“æπ—°ß“π∑’Ë¥‘π
«—𠇥Õ◊ π ªï ®¥∑–‡∫’¬π 𓬠°. μ“¡ ≠— ≠“ §ß‡À≈Õ◊ ‡≈¢∑Ë’¥‘π ≈ß≈“¬¡Õ◊ ™ÕË◊
𓬠¢. ‚©π¥∑¥Ë’ π‘ „À¡à ª√–∑∫— μ√“
«—π∑.’Ë .................... ®”πÕß ºŸ√â ∫— ®”πÕß ‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
‡¥Õ◊ π................... «“ «“
æ.». .....................
Ò››››› › (≈ß™◊ËÕ)........................

«—π∑’Ë..................... ¢“¬μ“¡§” ß—Ë »“≈ 𓬠°. 𓬠¢. Ò››››› › (≈ß™◊ËÕ)........................
‡¥◊Õπ...................
æ.». .....................

«π— ∑.Ë’ .................... √–ß∫— ®”πÕß π“¬ ¢. 𓬠¢. Ò››››› › (≈ß™◊ÕË )........................

‡¥Õ◊ π................... (ÀπÈ’‡°≈Ë◊Õπ°≈π◊ °—π) ºŸ√â ∫— ®”πÕß º√⟠—∫‚Õπ

æ.». .....................

À¡“¬‡Àμÿ °àÕπ®¥∑–‡∫¬’ π√–ß∫— ®”πÕß (ÀπÈ’‡°≈ËÕ◊ π°≈◊π°π— ) ®–μâÕß¡’°“√¬π◊Ë §”¢Õ·≈–®¥∑–‡∫¬’ π
ª√–‡¿∑¢“¬μ“¡§” Ë—ß»“≈ ‚¥¬¡’°“√®”πÕß쥑 ‰ª¥â«¬°Õà π

ÚÛÛ

ÚÛÙ

μ—«Õ¬à“ßÀ¡“¬‡≈¢ ÚÒ (∑.¥. Ò)
∑∫Ë’ “â π
ç°√≥’·°â‰¢Õ—μ√“¥Õ°‡∫È’¬é ∑’Ë «π/‰√à
∑’Ëπ“
§”¢Õ®¥∑–‡∫’¬π ∑‘ ∏·‘ ≈–π‘μ‘°√√¡ ∑Ë’..............
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑¥Ë’ π‘ ª√–‡¿∑.·...°..â‰..¢..À..π..’ÈÕ...π— ..®..”..π..Õ...ß..‡.ª..πì...ª..√..–..°..—π.. πÕ°‡¢μ
„π‡¢μ

μ”·Àπàß∑Ë’¥‘π

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

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

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

—Õμ√“¥Õ°‡∫’È¬μ“¡ —≠≠“®”πÕß ≈ß«—π∑’Ë...........‡¥◊Õπ...........................æ.». ............... Ë´÷ß°”À𥉫â„πÕ—μ√“............... —∫¥πÈ’ Ÿà§ — ≠≠“‰¥âμ°≈ß‚©π¥∑’Ë¥‘π
°”Àπ¥Õ—μ√“¥Õ°‡∫’Ȭ„À¡à‡ ìªπÕ—μ√“...............................μ“¡∫—π∑÷°¢âÕμ°≈ß ≈ß«—π ’Ë∑...........‡ ◊¥Õπ...........................æ.». ...............
‡®â“æπ—°ß“π Ë’∑ ‘¥π ‡≈¢∑Ë.’ ...........................................‡≈à¡........................................Àπâ“....................................
®”π«π∑¥Ë’ ‘π.................Ò..................‰√à................›.................ß“π................›...................μ“√“ß«“

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

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

Ú. ¢“â 懮â“..............π..“..¬....°............................ ‡≈¢ª√–®”μ—«ª√–™“™π ºâ.Ÿ ..®..”..π..Õ..ß...........................

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

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

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

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

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

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

‚ ¥ À¡“â ¬ §àŸ ¡√ ™◊ËÕ....................................................... —≠™“μ.‘ ......................
Õ¬∑àŸ ∫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 ....................

Ù. ¢“â 懮“â ¢Õ· ¥ß√“§“∑√æ— ¬∑å ¢Ë’ Õ∑”πμ‘ ‘°√√¡π’ȇªπì ‡ßπ‘ .............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à

(Ò) ¢â“懮Ⓣ¡à‰¥√â ∫— ‚Õπ·∑πÀ√◊Õ‡æ◊ËÕª√–‚¬™πå·°∫à §ÿ §≈μ“à ߥ“â «
(Ú) √“§“∑√æ— ¬å∑·’Ë  ¥ß‰«â„π Ù. ‡ªìπ√“§“∑Ë·’ ∑®â √ß‘
(Û) .....................................................................................................................................................................

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«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
≈ß™◊ËÕ......................π..“..¬....°.........................ºâŸ¢Õ ®”πÕß
≈ß™◊ËÕ......................π..“..¬....¢.........................ºâŸ¢Õ √—∫®”πÕß
≈ß™Ë◊Õ......................................................º Ÿâ 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‘ ...............................................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 ................................‡¥◊Õπ............................................æ.»......................

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

μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÚÒ ÚÛı

(∑.¥. Òˆ)

∫π— ∑°÷ ¢âÕμ°≈ß·°â‰¢Àπ’ÈÕπ— ®”πÕ߇ªπì ª√–°π—

∑Ë’¥‘π
√–«“ß...............................................................................μ”∫≈........................................................................
‡≈¢∑’¥Ë π‘ ...............................Àπ“â  ”√«®............................Õ”‡¿Õ.......................................................................
‚©π¥À¡“¬‡≈¢∑.’Ë ..............................................................®—ßÀ«—¥.......................................................................
∑«Ë’ à“°“√.....................................................................

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

¢“â 懮“â .....................π..“..¬....°.......º..Ÿâ®..”..π..Õ...ß.................................................... ‡≈¢ª√–®”μ—«ª√–™“™π

.....................π..“..¬....¢.......º..Ÿâ√..—∫..®..”..π...Õ..ß................................................

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

Õ¬Ÿà∑’∫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..............................
¢//Õ//ª//Ø//≠‘ //“/≥///μ//π//·/≈//–//„/À//∂â //Õâ //¬/§//”//μ/Õà//.....‰..¥..â∑...”.∫...—π..∑..÷°...¢..âÕ..μ...°..≈..ß..μ..Õà...‡.®..“â..æ..π...°— ..ß..“..π..∑...Ë’¥..‘π.....................................................................................

¥//«â//¬//§//«/“/¡// //—μ//¬//å®/√//‘ß/ ¥ß— μàÕ‰ªπ’È :›
......................∑...¥’Ë ..‘π...·..ª..≈...ß..‡.§...√..◊ËÕ...ß..À..¡...“..¬..¢..â“..ß..∫...π..π...È’.¢...â“..æ..‡..®..â“...π...“..¬....°.....º...®âŸ ..”..π..Õ...ß..‰..¥..®â..”..π...Õ..ß..‰..«..°â ..—∫....π...“..¬....¢.....º...â√Ÿ ..∫— ..®..”..π...Õ..ß..μ...“..¡..À...π..ß—... ..◊Õ.. ...≠—...≠....“..®..”..π..Õ. ß
.≈..ß..«..—π...∑..’Ë......................‡.¥..Õ◊...π........................................æ....»...................................‡..æ..Õ◊Ë...‡.ª...πì ..ª...√..–..°...π— ..°..“..√..°...⬟ ..◊¡...‡.ß..π‘...´..ß÷Ë..º...Ÿ®â ..”..π..Õ...ß..°..¬âŸ...¡◊ ..‰..ª..®..“..°...º..√Ÿâ..—∫...®..”..π..Õ...ß..‡.ª...ìπ..®...”..π..«..π............................................∫..“..∑...
.(......................................................)...‚..¥..¬...°..”..À...π..¥..Õ...—μ..√...“..¥..Õ...°..‡.∫...’¬È ..‰..«..â„.π...Õ..—μ...√..“....................................π..—Èπ....∫...¥— ..π...’È .¢...“â ..æ..‡..®..“â ..∑..Èß—.. ...Õ..ß..Ω...“É ..¬..μ...°..≈...ß..°..”..À...π..¥..Õ...—μ..√...“..¥..Õ...°..‡.∫...È’¬..μ...“..¡.. ...—≠...≠...“..
.¥..ß— ..°...≈..“à ..«..„.À...¡..à..‡.ª...ìπ..Õ...—μ..√..“..........................................................................................................................................................................................................
......................∫...—π..∑...÷°..¢..Õâ...μ..°...≈..ß..π...’∑È ..”..‰..«..Àâ ..π...÷ßË ..©..∫...∫— ....‡.°...Á∫..‰..«..â .≥..... ...”.π...°—..ß..“..π...∑..¥’Ë...π‘....∑..—ßÈ... ..Õ..ß...Ω..“É..¬..‰..¥..μâ...√..«..®..¥...Ÿ∫..—π...∑..÷°...¢..âÕ..μ...°..≈...ß...·...≈..–..‡..¢..â“..„.®...¢..Õâ..§...«..“..¡........
μ...≈..Õ...¥..·...≈..«â....®..ß÷..≈...ß..≈..“..¬...¡..◊Õ...™..◊ÕË ..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....................................................

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............................................................................................≈..ß...™..◊ËÕ...........................................................π......“....¬.........°......................................................º..⟮...”..π..Õ..ß.......................................
............................................................................................≈..ß...™..Ë◊Õ...........................................................π......“....¬.........¢......................................................º..√âŸ..—∫...®..”..π...Õ..ß..................................
............................................................................................≈..ß...™..Ë◊Õ....................................................................................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..◊ËÕ.....................................................................................................................................æ...¬..“..π...........................................
.............................∫...π— ..∑...°÷ ..¢..Õâ...μ..°...≈..ß..π...’ȉ..¥..∑â...”..μ..Õà...À..π...“â ......................................................................................................................................
............................................................................................≈..ß...™..Ë◊Õ.....................................................................................................................................‡.®..“â..æ...π...°— ..ß..“..π..∑...¥’Ë..π‘..........................
..........................................................................................................ª..√..–..∑...—∫..μ...√..“..μ...”.·...À..π...àß..‡.ª...πì .. ...”..§..≠—..........................................................

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μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÚÒ ÚÛˆ

 “√∫—≠®¥∑–‡∫¬’ π

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

«—π∑.’Ë .................... ·°â‰¢ÀπÈÕ’ π— ®”πÕß Õμ— √“¥Õ°‡∫¬’È μ“¡ ≠— ≠“®”πÕß ≈ß«π— ∑.Ë’ .........‡¥◊Õπ..................æ.»...........´÷Ëß°”À𥉫â (≈ß™◊ÕË )........................

‡¥◊Õπ................... ‡ªìπª√–°—π „πÕμ— √“..............π—Èπ ∫—¥π’È §Ÿ à —≠≠“‰¥âμ°≈ß°—π°”Àπ¥Õμ— √“¥Õ°‡∫’Ȭ„À¡‡à ªπì ................

æ.». .................... μ“¡∫—π∑÷°¢Õâ μ°≈ß ≈ß«—π∑Ë’.........‡¥◊Õπ......................æ.».............

ÚÛ˜

μ—«Õ¬à“ßÀ¡“¬‡≈¢ ÚÚ (∑.¥. Ò)
∑∫’Ë “â π
ç°√≥’‡≈‘°ª√–°—πÀπ≈’È Ÿ°Àπ’È∫“ߧπé ∑’ Ë «π/‰√à
∑Ë’π“
§”¢Õ®¥∑–‡∫¬’ π ‘∑∏‘·≈–πμ‘ ‘°√√¡ ∑.Ë’ .............
·≈–°“√ Õ∫ «π ‘∑∏‘„π∑’Ë¥‘π ª√–‡¿∑.·...°..â‰..¢..À..π..’ÈÕ...π— ..®..”..π..Õ...ß..‡.ª..πì...ª..√..–..°..—π.. πÕ°‡¢μ
„π‡¢μ

μ”·Àπàß∑’Ë¥‘π

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

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

°“√®”πÕß≈ß«—π∑’Ë...........‡¥◊Õπ...........................æ.». ...............‡ªìπª√–°—πÀπ’È¢Õß......π...“...¬.....§.....·≈–.......π...“...¬.....ß....∫—¥πÈ’ àŸ§°√≥’μ°≈ß°—π‡≈‘°ª√–°—πÀπÈ’ Àπâ“ ”√«®..................................................................................®ß— À«—¥........................................................................................
¢Õß........π...“...¬.....§........§ß®”πÕ߇ªìπª√–°—πÀπÈ’¢Õß.........π..“...¬.....ß........μàÕ‰ª μ“¡∫—π∑÷° â¢Õμ°≈ß ≈ß«—π∑’Ë...........‡ ◊¥Õπ...........................æ.». ...............
‡®â“æ —π°ß“π Ë’∑ ‘¥π ‚©π¥∑¥Ë’ π‘

‡≈¢∑.’Ë ...........................................‡≈à¡........................................Àπ“â ....................................
®”π«π∑’Ë¥π‘ .................Ò..................‰√à................›.................ß“π................›...................μ“√“ß«“

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

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

Ú. ¢â“懮â“..............π..“..¬....°............................ ‡≈¢ª√–®”μ—«ª√–™“™π ºŸâ...®..”..π..Õ..ß...........................

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

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

Õ¬àŸ∑∫’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.....................

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

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

‚ ¥ À¡“â ¬ §Ÿ à ¡√ ™ÕË◊ ....................................................... —≠™“μ‘.......................
Õ¬Ÿ∑à 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∑”π‘μ°‘ √√¡π’‡È ªπì ‡ß‘π.............................›............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à

(Ò) ¢â“懮Ⓣ¡à‰¥√â —∫‚Õπ·∑πÀ√◊Õ‡æËÕ◊ ª√–‚¬™πå·°∫à ÿ§§≈μ“à ߥ⓫
(Ú) √“§“∑√æ— ¬∑å Ë’· ¥ß‰«â„π Ù. ‡ªπì √“§“∑’·Ë ∑®â √ß‘
(Û) .....................................................................................................................................................................

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«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
≈ß™Õ◊Ë ......................π..“..¬....°.........................ºŸâ¢Õ ®”πÕß
≈ß™Ë◊Õ......................π..“..¬....¢.........................ºŸâ¢Õ √—∫®”πÕß
≈ß™Õ◊Ë ......................................................º Ÿâ 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‘ ...............................................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™◊ËÕ.......................................................
(......................................................)
‡®â“æπ—°ß“π∑Ë’¥‘π

ÚÛ¯

μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÚÚ

(∑.¥. Òˆ)

∫π— ∑°÷ ¢Õâ μ°≈ß·°â‰¢ÀπÕ’È —π®”πÕ߇ªìπª√–°π—

∑Ë’¥‘π
√–«“ß...............................................................................μ”∫≈........................................................................
‡≈¢∑Ë¥’ ‘π...............................Àπ“â  ”√«®............................Õ”‡¿Õ.......................................................................
‚©π¥À¡“¬‡≈¢∑Ë’...............................................................®—ßÀ«¥— .......................................................................
∑’Ë«à“°“√.....................................................................

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

¢“â 懮“â .....................π..“..¬....°.......º..®âŸ..”..π..Õ...ß.................................................... ‡≈¢ª√–®”μ—«ª√–™“™π

.....................π..“..¬....¢.......º..Ÿâ√..—∫..®..”..π...Õ..ß................................................

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

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

μ”∫≈/·¢«ß...............................Õ”‡¿Õ/‡¢μ...............................®—ßÀ«—¥................................À¡“¬‡≈¢‚∑√»æ— ∑.å .............................
¢//Õ//ª//Ø//≠‘ //“/≥///μ//π//·/≈//–//„/À//∂â //Õâ //¬/§//”//μ/àÕ//.....‰..¥..â∑...”.∫...π— ..∑..÷°...¢..Õâ ..μ...°..≈..ß..μ..Õà...‡.®..“â..æ..π...°— ..ß..“..π..∑...¥Ë’ ..‘π.....................................................................................

¥//â«//¬//§//«/“/¡// //—μ//¬//å®/√//ß‘ / ¥—ßμÕà ‰ªπÈ’ :›
......................∑...’¥Ë ..‘π...·..ª..≈...ß..‡.§...√..ËÕ◊...ß..À..¡...“..¬..¢..â“..ß..∫...π..π...È’.¢...“â ..æ..‡..®..“â ...π...“..¬....°....º...®âŸ ..”..π..Õ...ß..‰..¥..®â..”..π...Õ..ß..‰..«..°â ..—∫....π...“..¬....¢....º...Ÿ√â ..∫— ..®..”..π...Õ..ß..μ...“..¡..À...π..ß—... ..Õ◊.. ...—≠...≠....“..®..”..π..Õ. ß
.≈..ß..«..π—...∑..Ë’.........................‡..¥..◊Õ...π....................................................æ....»....................................‡.æ...◊ËÕ..‡.ª...πì..ª...√..–..°...π— ..À...π..È¢’..Õ...ß...........π......“....¬.........§..................·..≈..–.........π......“....¬.........ß...............∫..¥—...π..’È..¢..“â..æ...‡.®..“â..∑...ß—È .. ..Õ...ß..Ω...É“..¬..μ..°...≈..ß..°...π— ..
.‡.≈..°‘...ª..√..–...°..—π..À...π..È’¢...Õ..ß....................π.....“....¬.........§......................§...ß..®..”..π...Õ..ß..‡..ª..ìπ...ª..√..–...°..π—..À...π..’¢È...Õ..ß................π......“...¬.........ß..........................μ...Õà..‰..ª.. ...à«..π..‡..ß..ÕË◊..π...‰.¢...·..≈..–...¢..Õâ ..μ...°..≈...ß..Õ..◊Ëπ...Ê....§..ß..‡..ª..ìπ...‰.ª...μ..“..¡.....
. ..—≠...≠....“..®..”..π..Õ...ß..‡.¥...¡‘ ..∑...ÿ°..ª...√..–..°..“..√....................................................................................................................................................................
......................∫...—π..∑...°÷ ..¢..âÕ...μ..°...≈..ß..π...È∑’ ..”..‰..«..Àâ ..π...ßË÷ ..©..∫...∫— ....‡.°...Á∫..‰..«..â .≥..... ...”.π...—°..ß..“..π...∑..¥Ë’...‘π....∑..—ßÈ... ..Õ..ß...Ω..É“..¬..‰..¥..âμ...√..«..®..¥...∫Ÿ ..π—...∑..°÷...¢..Õâ..μ...°..≈...ß...·...≈..–..‡..¢..“â..„.®...¢..Õâ..§...«..“..¡........
μ...≈..Õ...¥..·...≈..â«....®..÷ß..≈...ß..≈..“..¬...¡..◊Õ...™..Õ◊Ë ..À...√..◊Õ..≈...ß..≈..“..¬...æ..¡‘...æ...πå ..È‘«..¡...◊Õ..‰.«...‡â .ª..πì...À..≈...—°..∞..“..π...μ..àÕ...À..π...“â ..æ..¬...“..π..·...≈..–..‡..®..â“..æ..π...°— ..ß..“..π...∑..’¥Ë...π‘ ....................................................

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............................................................................................≈..ß...™..Ë◊Õ...........................................................π......“....¬.........°......................................................º..⟮...”..π..Õ..ß.......................................
............................................................................................≈..ß...™..Ë◊Õ...........................................................π......“....¬.........¢......................................................º..âŸ√..∫—...®..”..π...Õ..ß..................................
............................................................................................≈..ß...™..◊ËÕ....................................................................................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..Ë◊Õ.....................................................................................................................................æ...¬..“..π...........................................
.............................∫...—π..∑...÷°..¢...Õâ ..μ...°..≈..ß..π...È’‰..¥..∑â...”..μ..Õà...À..π...“â ......................................................................................................................................
............................................................................................≈..ß...™..◊ËÕ.....................................................................................................................................‡.®..“â..æ...π...°— ..ß..“..π..∑...¥’Ë..π‘..........................
..........................................................................................................ª..√..–..∑...—∫..μ...√..“..μ...”.·...À..π...ßà ..‡.ª...πì.. ...”..§..—≠..........................................................

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μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÚÚ

 “√∫—≠®¥∑–‡∫¬’ π

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

«π— ∑’Ë..................... ·°â‰¢ÀπÈÕ’ —π®”πÕß °“√®”πÕß≈ß«—π∑’Ë..........‡¥Õ◊ π..................æ.»...........‡ªπì ª√–°—πÀπ¢È’ Õß.....π...“..¬.....§........·≈– (≈ß™◊ËÕ)........................

‡¥◊Õπ................... ‡ªìπª√–°—π ...π...“...¬.....ß......∫—¥π’È §à°Ÿ √≥’μ°≈ß°π— ‡≈°‘ ª√–°—πÀπÈ¢’ Õß..π...“...¬.....§.....§ß®”πÕ߇ªìπª√–°π— Àπ’È

æ.». .................... ¢Õß....π...“...¬.....ß......μÕà ‰ª μ“¡∫π— ∑°÷ ¢âÕμ°≈ß ≈ß«—π∑’.Ë ........‡¥◊Õπ......................æ.».............

ÚÛ˘

ÚÙ

μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÚÛ (∑.¥. Ò)
∑∫Ë’ “â π

∑’Ë «π/‰√à

∑Ë’π“

∑’Ë..............

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

„π‡¢μ

·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑¥Ë’ π‘ ª√–‡¿∑.·..°...â‰.¢..‡..ª..≈..¬Ë’...π..·..ª...≈..ß..®..”..π..Õ...ß...(.·...ª..≈..ß..À...π..’È„.À...¡. )à

μ”·Àπàß∑Ë’¥‘π

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

μ“¡ —≠≠“®”πÕß ≈ß«—π∑’Ë...........‡ ◊¥Õπ...........................æ.». ...............‡ ìªπª√–°—πÀπÈ’¢Õß...............................πÈ—π —∫¥π’È §àŸ°√≥’‰ â¥μ°≈ß‚Õπ°“√®”πÕ߉ª‡≈¢∑Ë’¥‘π..................................................................................... Õ”‡¿Õ........................................................................................
ª√–°—πÀπÈ’¢Õß..................................μ“¡∫—π∑÷° â¢Õμ°≈ß ≈ß«—π∑’Ë...........‡ ◊¥Õπ...........................æ.». ...............
‡®â“æπ—°ß“π Ë’∑ ‘¥π Àπ“â  ”√«®..................................................................................®—ßÀ«—¥........................................................................................

‚©π¥∑Ë’¥π‘

‡≈¢∑.Ë’ ...........................................‡≈à¡........................................Àπ“â ....................................
®”π«π∑’¥Ë ‘π.................Ò..................‰√.à ...............›.................ß“π................›...................μ“√“ß«“

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

‰¥âªØ≠‘ “≥μπ·≈«â ¢Õ„À∂â Õâ ¬§”¥â«¬§«“¡ —쬮å √‘ß ∂“â ¢â“懮ⓄÀâ∂âÕ¬§”‰¡‡à ªì𧫓¡®√ß‘ „Àâ„™∂â âÕ¬§”πÈ’¬π— ¢â“懮Ⓞπ∑“ߧ¥’Õ“≠“‰¥â

Ú. ¢“â 懮â“..............π..“..¬...°............................. ‡≈¢ª√–®”μ—«ª√–™“™π ºâŸ...®..”..π..Õ..ß...........................

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

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

Õ¬à∑Ÿ ∫’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.....................

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

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

‚ ¥ À¡“â ¬ §àŸ ¡√ ™ËÕ◊ ....................................................... —≠™“μ.‘ ......................
Õ¬∑Ÿà Ë∫’ “â π/À¡à∫Ÿ â“π..........................‡≈¢∑’Ë................μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡Ÿà∑Ë’..............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®ß— À«¥— .................................À¡“¬‡≈¢‚∑√»—æ∑å.....................

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

(Ò) ¢“â 懮“â ‰¡à‰¥â√∫— ‚Õπ·∑πÀ√◊Õ‡æÕ◊Ë ª√–‚¬™π·å °∫à ÿ§§≈μà“ߥ⓫
(Ú) √“§“∑√—æ¬∑å ·Ë’  ¥ß‰«â„π Ù. ‡ªìπ√“§“∑Ë’·∑®â √ß‘
(Û) .....................................................................................................................................................................

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«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
≈ß™◊ËÕ......................π..“..¬....°.........................ºâŸ¢Õ ®”πÕß
≈ß™◊ÕË ......................π..“..¬....¢.........................ºâŸ¢Õ √—∫®”πÕß
≈ß™ÕË◊ ......................................................º Ÿâ Õ∫ «π

(......................................................)
 ”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 ·μ«à —π∑.’Ë ................................‡¥Õ◊ π............................................æ.»......................

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

μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÚÛ ÚÙÒ

(∑.¥. Òˆ)

∫π— ∑°÷ ·°â‰¢‡ª≈’¬Ë π·ª≈ß®”πÕß (·ª≈ßÀπ’È„À¡à)

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

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

¢“â 懮“â .....................π..“..¬....°.......º..⮟..”..π..Õ...ß.................................................... ‡≈¢ª√–®”μ—«ª√–™“™π

.....................π..“..¬....¢.......º..â√Ÿ ..—∫..®..”..π...Õ..ß................................................

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

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

μ”∫≈/·¢«ß...............................Õ”‡¿Õ/‡¢μ...............................®—ßÀ«¥— ................................À¡“¬‡≈¢‚∑√»æ— ∑å..............................
¢//Õ//ª//Ø//≠‘ //“/≥///μ//π//·/≈//–//„/À//∂â //âÕ//¬/§//”//μ/àÕ//.....‰..¥..∑â...”.∫...—π..∑..÷°...¢..âÕ..μ...°..≈..ß..μ..àÕ...‡.®..â“..æ..π...—°..ß..“..π..∑...¥Ë’ ..‘π.....................................................................................

¥//«â//¬//§//«/“/¡// //μ—//¬//å®/√//ß‘ / ¥ß— μÕà ‰ªπ’È :›
......................μ...“..¡..∑...Ë’¢..“â ..æ..‡..®..“â...π...“..¬....°....‰..¥..®â...”..π..Õ..ß...∑..Ë’¥...π‘ ..·...ª..≈..ß...‡.§...√..ËÕ◊ ..ß..À...¡..“..¬...¢..“â..ß..∫...π..π..’È.‰.«..â·...°..à..π..“..¬....¢.....‡..æ..◊ÕË...ª...√..–..°..—π...À..π...¢’È ..Õ..ß..........................................
.μ..“..¡..À...π..ß—... ..◊Õ.. ...≠— ...≠....“..®..”..π..Õ...ß...≈...ß..«..π— ...∑..Ë’.........................‡.¥...Õ◊ ..π.....................................................æ....»...................................π...π—È .........................................................................................
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.‡.¥..◊Õ...π...............................................æ....»...........................´..ßË÷..‰..¥..â ..ßà...¡..“..æ...√..âÕ..¡...∫..π—...∑..÷°...π..È’..¢..“â..æ...‡.®..“â..∑...È—ß.. ..Õ...ß..Ω..É“..¬...®..÷ß..μ..°...≈..ß..‚..Õ..π...°..“..√..®..”..π...Õ..ß..√...“.¬...π..È’..‰.ª...ª..√...–..°..—π...À..π...¢’È ..Õ..ß......................................
.‡.ª..ìπ...®..”..π..«...π..‡.ß...π‘ ......................................∫..“..∑....(.......................................................)...‚..¥..¬..∂...◊Õ..μ...“..¡..¢...âÕ..§...«..“..¡..„.π... ..—≠....≠...“..®..”..π...Õ..ß..‡..¥..‘¡...∑..ÿ°...ª..√..–..°...“..√....................................................
......................∫...—π..∑...°÷ ..¢..Õâ...μ..°...≈..ß..π...È’∑..”..‰..«..Àâ ..π...Ëß÷ ..©..∫...∫— ....‡.°...∫Á ..‰..«..â .≥..... ...”.π...°—..ß..“..π...∑..¥Ë’...π‘....∑..ßÈ—... ..Õ..ß...Ω..É“..¬..‰..¥..âμ...√..«..®..¥...Ÿ∫..—π...∑..÷°...¢..Õâ..μ...°..≈...ß...·...≈..–..‡..¢..“â..„.®...¢..âÕ..§...«..“..¡........
μ...≈..Õ...¥..·...≈..â«....®..ß÷..≈...ß..≈..“..¬...¡..Õ◊...™..◊ËÕ..À...√..◊Õ..≈...ß..≈..“..¬...æ..‘¡...æ...åπ..È‘«..¡...Õ◊ ..‰.«...â‡.ª..ìπ...À..≈...—°..∞..“..π...μ..Õà...À..π...â“..æ..¬...“..π..·...≈..–..‡..®..â“..æ..π...°— ..ß..“..π...∑..’Ë¥...‘π....................................................

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............................................................................................≈..ß...™..◊ËÕ...........................................................π......“....¬.........°......................................................º..Ÿâ®...”..π..Õ..ß.......................................
............................................................................................≈..ß...™..◊ËÕ...........................................................π......“....¬.........¢......................................................º..Ÿâ√..—∫...®..”..π...Õ..ß..................................
............................................................................................≈..ß...™..◊ËÕ....................................................................................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..Ë◊Õ.....................................................................................................................................æ...¬..“..π...........................................
.............................∫...π— ..∑...°÷ ..¢..âÕ...μ..°...≈..ß..π...È’‰..¥..∑â...”..μ..Õà...À..π...“â ......................................................................................................................................
............................................................................................≈..ß...™..Ë◊Õ.....................................................................................................................................‡.®..“â..æ...π...°— ..ß..“..π..∑...¥’Ë..π‘..........................
..........................................................................................................ª..√..–..∑...—∫..μ...√..“..μ...”.·...À..π...àß..‡.ª...πì .. ...”..§..≠—..........................................................

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μ—«Õ¬“à ßÀ¡“¬‡≈¢ ÚÛ ÚÙÚ

 “√∫—≠®¥∑–‡∫’¬π

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

«—π∑’Ë..................... ·°â‰¢‡ª≈¬Ë’ π·ª≈ß μ“¡ ≠— ≠“®”πÕß ≈ß«—π∑’Ë..........‡¥◊Õπ.................æ.»..........‡ªìπª√–°—πÀπ¢’È Õß................. (≈ß™◊ËÕ)........................

‡¥◊Õπ................... ®”πÕß ∫¥— πÈ’ §àŸ°√≥‰’ ¥âμ°≈ß‚Õπ°“√®”πÕ߉ªª√–°π— ÀπÈ¢’ Õß.........................................................

æ.»..................... (·ª≈ßÀπÈ’„À¡à) μ“¡∫—π∑°÷ ¢âÕμ°≈ß ≈ß«—π∑’.Ë ........‡¥◊Õπ......................æ.».............

ÚÙÛ

μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÚÙ (∑.¥. Ò)
∑∫Ë’ “â π
(§°àŸ √≥¡’ “¢Õ®¥∑–‡∫¬’ π‡æ¬’ ßΩ“É ¬‡¥’¬«)
∑Ë’ «π/‰√à

∑’Ëπ“

∑Ë’..............

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

„π‡¢μ

·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑¥’Ë ‘π ª√–‡¿∑..‡.ª..≈...’ˬ..π..™..Ë◊Õ...º..Ÿâ√..—∫..®...”.π...Õ..ß.............................

μ”·Àπàß∑’Ë¥‘π (√–À«à“ß°®‘ °“√∑Ë’‡ªìππ‘μ‘∫§ÿ §≈‡¥¬’ «°π— )

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

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

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

‚©π¥∑¥Ë’ ‘π

‡≈¢∑.Ë’ ...........................................‡≈à¡........................................Àπ“â ....................................
®”π«π∑Ë’¥‘π.................Ò..................‰√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’ ·≈–

‰¥âªØ≠‘ “≥μπ·≈â« ¢Õ„Àâ∂Õâ ¬§”¥â«¬§«“¡ μ— ¬å®√ß‘ ∂â“¢“â 懮ⓄÀâ∂âÕ¬§”‰¡‡à ªì𧫓¡®√‘ß„Àâ„™â∂Õâ ¬§”π’¬È —π¢â“懮“â „π∑“ߧ¥’Õ“≠“‰¥â

Ú. ¢“â 懮â“.∏..π...“..§..“..√...‡.Õ....°..‘®...°..“..√..«..‘‡.∑..»...∏..π..°..®‘..-.. ‡≈¢ª√–®”μ—«ª√–™“™π ºâŸ...√..—∫..®..”..π..Õ...ß......................

 “¢“°√ÿ߇∑æœ
.................................................

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

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

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

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

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

................................................

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

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

Õ¬à∑Ÿ ∫’Ë “â π/À¡à∫Ÿ “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∑”π‘μ°‘ √√¡πȇ’ ªìπ‡ß‘π.............................›............................∫“∑.........›........... μ“ߧå

ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à

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

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

(Û) .‡..ª..πì..°...“.√..‡..ª..≈..’ˬ...π..™..Õ◊Ë...º..Ÿâ√..∫— ..®..”..π..Õ...ß..®..“..°...∏...π..“..§..“..√...‡..Õ...°...‘®..°..“..√..«..‡‘ .∑..»...∏..π..°..®‘... ..“..¢..“..°..√..ßÿ ..‡.∑...æ..œ....μ..“..¡.. ..—≠....≠...“..®..”..π..Õ..ß................

.≈...ß..«..—π..∑..Ë.’......................‡.¥...◊Õ..π.................................................æ.....»...........................‰.ª..‡..ª..πì..™...Ë◊Õ...∏...π..“..§..“..√...‡..Õ...´...ßË÷ ..‡.ª..ìπ...°..‘®..°..“..√..∑..’‡Ë..ª..ìπ..π...‘μ..∫‘..ÿ§...§..≈...‡.¥..’¬..«..°...—π..........

.μ...“..¡..°..Æ...À..¡..“..¬....‚.¥...¬..‡.À..μ...ÿ∑..∏Ë’ ..π...“.§...“..√...‡.Õ....°..‘®..°...“..√..«.‡‘..∑..»..∏...π..°..‘®.... ..“..¢..“..°..√..ßÿ ..‡.∑...æ..œ....‰.¥..â√..∫—...Õ..π..≠ÿ....“..μ..®..“..°..°..√..–..∑...√..«..ß..°..“..√..§..≈..ß—.....

„Àªâ ‘®°“√·≈–‰¥¥â ”‡ππ‘ °“√‚Õπ π‘ ∑√æ— ¬å «π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................

·≈–Àπ’ È π‘ ¢Õß°®‘ °“√«‡‘ ∑»∏π°®‘ ‰ª¬ß— °®‘ °“√ ≈ß™◊ËÕ..........................›............................ºŸâ¢Õ ®”πÕß
¢Õß ∏𓧓√ ‡Õ ·≈«â μ“¡Àπß—  ◊Õ ≈ß™Ë◊Õ..................∏..π...“..§..“..√...‡.Õ.....................ºâŸ¢Õ √—∫®”πÕß
°√–∑√«ß°“√§≈ß— ∑.Ë’ ..............≈ß«π— ∑.Ë’ ......... ≈ß™Õ◊Ë ......................................................º âŸ Õ∫ «π
‡¥Õ◊ π.................æ.»..............
(......................................................)

 ”À√—∫æπ°— ß“π‡®“â Àπâ“∑Ë’

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

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

‚©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™Ë◊Õ.......................................................

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

‡®â“æπ—°ß“π∑’Ë¥‘π

ÚÙÙ (∑.¥. ˘)

μ—«Õ¬“à ßÀ¡“¬‡≈¢ ÚÙ
(§Ÿà°√≥’¡“¢Õ®¥∑–‡∫¬’ π‡æ¬’ ßΩÉ“¬‡¥’¬«)

§”¢Õ...............‡.ª...≈..’ˬ..π...™..Ë◊Õ..º...âŸ√..—∫..®..”..π...Õ..ß...............

(√–À«à“ß°‘®°“√∑Ë’‡ªìππμ‘ ‘∫ÿ§§≈‡¥’¬«°—π)

©∫∫— ∑.’Ë ......................................

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

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

¢“â 懮“â ...........................∏..π...“.§...“..√...‡.Õ......................................................... ‡≈¢ª√–®”μ—«ª√–™“™π

Õ“¬ÿ......Û.........ªï ‡™È◊Õ™“μ.‘ ..........‰.∑..¬............... ≠— ™“μ.‘ .........‰.∑...¬...............∫¥‘ “/¡“√¥“™ËÕ◊ .....................................................................

Õ¬àŸ∑’∫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 ......................

¢Õ¬πË◊ §”¢ÕμàÕ‡®“â æπ—°ß“π∑¥Ë’ ‘π®—ßÀ«¥— ....................................................¥«â ¬§«“¡ μ— ¬®å √ß‘ «à“ :-
¢Õâ Ò. ¥â«¬...¢...â“.æ...‡.®..“â....∏..π..“..§..“..√....‡.Õ....º..⟮..—¥..μ...Èß— ..°..‘®..°..“..√..«..‡‘.∑...»..∏..π...°..®‘ .. ..“..¢..“..°..√..ÿß..‡..∑..æ..œ....¡..’§...«..“.¡...ª..√..–.. ..ß...§..¢å ..Õ..„..À..æâ...π..—°..ß..“..π..‡..®..â“.À...π..â“..∑..’Ë..

.‡.ª..≈..Ë’¬...π..™..Ë◊Õ...º..Ÿâ√..—∫..®..”..π...Õ..ß..∑..’Ë¥...‘π..·..ª...≈..ß..¢..â“..ß..μ..πâ....μ..“..¡... ..—≠...≠...“..®..”..π..Õ...ß..≈..ß..«..π— ..∑...Ë’............................‡.¥..◊Õ...π...............................................æ....»...................................®..“.°....∏..π...“.§...“..√...‡.Õ....°..®‘..°...“..√...
.«.‘‡..∑..»..∏...π..°..®‘.... ..“..¢..“..°..√..ÿß..‡.∑...æ..œ....‡.ª..πì...∏..π..“..§..“..√....‡.Õ....‚.¥..¬...‡.À..μ...∑ÿ ..’¢Ë..â“..æ...‡.®..â“...∏..π...“.§...“..√...‡.Õ....°..∫—....∏..π...“..§..“..√...‡.Õ....°..®‘...°..“..√..«..‘‡.∑..»...∏..π..°..®‘.. ...“.¢...“.°...√..ßÿ ..‡.∑..æ...œ..........
.¡..’∞..“..π..–..‡.ª...πì ..π..‘μ...∫‘ ..§ÿ...§..≈..‡..¥..’¬..«..°..—π....·..≈...–..∫..—¥...π..È’ .∏..π...“..§..“..√...‡..Õ...°...®‘ ..°..“..√..«..‘‡.∑..»...∏..π..°..‘®.. ...“..¢..“..°..√..ßÿ ..‡.∑..æ...œ...‰..¥..â√..∫—...Õ..π..≠ÿ...“..μ...®..“..°..°..√..–..∑..√..«..ß..°...“.√..§...≈..ß—..„.À...âª..¥î.......
.°..‘®..°..“..√...æ...√..Õâ ..¡..∑...ßÈ— ..‰.¥...â¥..”..‡.π..π‘...°..“..√..‚.Õ..π... ..π‘..∑...√..æ— ..¬..å·...≈..–..À..π...È ’ ..‘π..¢...Õ..ß..∏..π..“..§...“.√....‡.Õ....°..‘®..°..“..√..«..‘‡.∑...».. ..“..¢..“..°...√..ßÿ ..‡.∑..æ...œ...‰..ª..¬..ß—..°..‘®...°..“..√..¢..Õ..ß..∏..π...“.§...“..√...‡.Õ....·..≈..«â
.ª..√..“..°..Ø..μ...“..¡..À..π...—ß.. ..Õ◊ ..°..√..–...∑..√..«..ß..°..“..√..§..≈...—ß...∑...Ë’ ................≈..ß..«..π—...∑..Ë’............‡.¥...Õ◊ ..π................................æ....»...................∑..·Ë’...π..∫..¡...“.æ...√..âÕ..¡...π..È’ ..............................

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¢âÕ Ú. ©–ππÈ— ¢Õ„À‡â ®“â æπ°— ß“π∑¥’Ë π‘ ...¥...”.‡..π..π‘..°...“.√..‡..ª..≈..’ˬ...π..™..ËÕ◊...º..Ÿâ√..—∫..®..”..π..Õ...ß..„.À...â‡.ª..ìπ...™..Ë◊Õ..∏..π...“.§...“..√...‡.Õ....μ...“.¡...§..«..“..¡..ª...√..–.. ..ß..§...å¥..«â ..¬......

.„.π..°..“..√..π...È’‰.¥...â∫..Õ..°...°..≈..“à..«..°..“..√..‡.ª...≈..¬Ë’..π...™..Õ◊Ë ..º..Ÿâ√..—∫...®..”..π..Õ..ß..„..À..â≈..°Ÿ...À..π..È’·..≈...–..º..Ÿâ®..”..π..Õ...ß..∑..√..“..∫..·...≈..â«.................................................................................

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......................∏..π..“..§..“..√....‡.Õ................... ºâŸ¢Õ
........................................................ 欓π
........................................................ 欓π

μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÚÙ ÚÙı

(§àŸ°√≥¡’ “¢Õ®¥∑–‡∫’¬π∑ßÈ—  ÕßΩÉ“¬) (∑.¥. Ò)
°√≥¬’ —߉¡à¡°’ “√ª¥î °‘®°“√ ∑∫’Ë “â π
∑Ë’ «π/‰√à
∑’Ëπ“

∑.’Ë .............

§”¢Õ®¥∑–‡∫¬’ π ‘∑∏‘·≈–π‘μ‘°√√¡ πÕ°‡¢μ

„π‡¢μ

·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑¥Ë’ π‘ ª√–‡¿∑..‡.ª..≈...Ë’¬..π..™..◊ËÕ...º..Ÿâ√..—∫...®..”.π...Õ..ß.............................

μ”·Àπàß∑Ë’¥‘π (√–À«à“ß°®‘ °“√∑’‡Ë ªπì π‘μ∫‘ ÿ§§≈‡¥’¬«°—π)

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

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

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

‚©π¥∑’¥Ë ‘π

‡≈¢∑.Ë’ ...........................................‡≈¡à ........................................Àπâ“....................................
®”π«π∑’Ë¥‘π.................Ò..................‰√.à ...............›.................ß“π................›...................μ“√“ß«“

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

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

Ú. ¢â“懮“â .∏..π...“.§...“..√...‡.Õ....°..‘®..°...“..√..«.‘‡..∑..»..∏...π..°..®‘..-.. ‡≈¢ª√–®”μ—«ª√–™“™π º.⟠..√..—∫..®..”..π..Õ...ß......................
 “¢“°√ßÿ ‡∑æœ
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Õ“¬ÿ..................................ªï  —≠™“μ‘.........................................∫¥‘ “/¡“√¥“™ËÕ◊ .............................................................................

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

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

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

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

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

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

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

ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à

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

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

(Û) .‡.ª...πì ..°..“..√..‡.ª...≈..’ˬ..π...™..Õ◊Ë ..º...√Ÿâ ..∫— ..®..”..π..Õ...ß..®..“.°....∏..π...“.§...“..√...‡.Õ....°..‘®..°...“.√..«..‡‘..∑..»..∏...π..°..‘®.. ...“.¢...“.°...√..ÿß..‡.∑..æ...œ...μ...“.¡... ..—≠...≠...“..®..”..π...Õ..ß................
.≈..ß..«..—π...∑..Ë’.......................‡.¥..Õ◊...π.................................................æ....»...........................‰..ª..‡.ª...πì ..™..◊ËÕ....∏..π...“.§...“..√...‡.Õ....´..÷ßË..‡..ª..ìπ..°...‘®..°..“..√..∑..’ˇ.ª...ìπ..π..μ‘...∫‘ ..§ÿ...§..≈..‡..¥..’¬..«..°..π—...........
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¢Õß°‘®°“√«‡‘ ∑»∏π°®‘ ‰ª¬ß— °®‘ °“√¢Õß ∏𓧓√ ‡Õ ·≈«â «π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................

∏𓧓√ ‡Õ °‘®°“√«‡‘ ∑»∏π°‘® “¢“°√ÿ߇∑æœ
≈ß™ÕË◊ ......................................................ºŸâ¢Õ √—∫®”πÕß®”πÕß
≈ß™◊ÕË ..................∏...π..“..§..“..√...‡..Õ....................ºâŸ¢Õ √—∫®”πÕß
≈ß™ËÕ◊ ......................................................º âŸ Õ∫ «π

(......................................................)
 ”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¡......................................................Àπ“â ..................................................
®”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™◊ÕË .......................................................
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‡®â“æπ—°ß“π∑’Ë¥‘π

ÚÙˆ (∑.¥. ˘)

μ—«Õ¬“à ßÀ¡“¬‡≈¢ ÚÙ
(§Ÿà°√≥¡’ “¢Õ®¥∑–‡∫’¬π∑ß—È  ÕßΩ“É ¬)

§”¢Õ...............‡.ª...≈..’ˬ..π...™..Ë◊Õ..º...âŸ√..—∫..®..”..π...Õ..ß...............

(√–À«à“ß°®‘ °“√∑‡Ë’ ªπì π‘μ∫‘ §ÿ §≈‡¥’¬«°π— )

©∫—∫∑.’Ë ......................................

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

«—π∑’.Ë ...............‡¥◊Õπ.....................................æ.». ......................
∏𓧓√ ‡Õ °®‘ °“√«‡‘ ∑»∏π°‘® “¢“°√ÿ߇∑æœ
‡≈¢ª√–®”μ—«ª√–™“™π
¢â“懮“â ..∏..π..“..§..“..√....‡.Õ..................................................................................

Õ“¬.ÿ .....Û.........ªï ‡™◊ÕÈ ™“μ‘...........‰.∑..¬............... —≠™“μ.‘ .........‰.∑...¬...............∫¥‘ “/¡“√¥“™ËÕ◊ .....................................................................

Õ¬àŸ∑∫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 ......................

¢Õ¬π◊Ë §”¢ÕμàÕ‡®â“æπ—°ß“π∑’¥Ë ‘π®ß— À«—¥....................................................¥«â ¬§«“¡ μ— ¬å®√‘ß«“à :-
¢âÕ Ò. ¥â«¬...¢...“â .æ...‡.®..â“....∏..π..“..§..“..√....‡.Õ....°..‘®..°..“..√..«..‘‡.∑...»..∏..π..°...®‘ .. ..“..¢..“..°..√..ßÿ..‡.∑...æ..œ....·..≈..–..∏..π...“..§..“..√...‡.Õ....º...®âŸ ..—¥..μ..ß—È..°...®‘ ..°..“..√..«..‘‡.∑..»...∏..π..°..®‘...........

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·...ª..≈..ß..¢...“â .ß..μ...πâ ....μ..“..¡.. ..—≠....≠...“..®..”..π..Õ..ß..≈...ß..«..—π..∑...’Ë ...............‡.¥...Õ◊ ..π..............................æ...».....................®..“..°....∏..π..“..§...“.√....‡.Õ....°..‘®..°..“..√..«..‡‘.∑...»..∏..π...°..®‘.. ..“..¢..“..°..√..ÿß..‡..∑..æ...œ.
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.‰.ª..¬...ß— ..°..‘®..°..“..√..¢..Õ..ß..∏...π..“..§..“..√...‡..Õ...·...≈..«â....................................................................................................................................................

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¢âÕ Ú. ©–ππ—È ¢Õ„À‡â ®“â æπ°— ß“π∑¥’Ë π‘ ..¥..”..‡.π...π‘ ..°..“..√..‡.ª...≈..¬Ë’..π...™..◊ËÕ..º..Ÿâ√..∫—...®..”..π..Õ..ß..μ...“..¡.. ..≠—....≠...“..®..”..π..Õ..ß..¥...ß— ..°..≈..à“..«..„.À...‡â .ª..ìπ...™..◊ÕË..∏...π..“..§..“..√...‡..Õ...

.μ..“..¡..§..«..“..¡...ª..√..–.. ..ß..§...å¥..â«..¬....„.π..°...“.√..π...’ȉ.¥...∫â ..Õ...°..°..≈..à“..«..°..“..√..‡.ª...≈..’ˬ..π...™..Õ◊Ë ..º...√Ÿâ ..—∫..®..”..π..Õ..ß...„.À..≈â...Ÿ°..À..π..È·’...≈..–..º..Ÿâ®..”..π...Õ..ß..∑..√..“..∫..·...≈..â«.............................................

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∏𓧓√ ‡Õ °‘®°“√«‘‡∑»∏π°‘® “¢“°√ßÿ ‡∑æœ
...........................∏..π..“..§...“.√....‡.Õ......................... ºâŸ¢Õ

................................................................... 欓π

................................................................... 欓π

μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÚÙ

 “√∫≠— ®¥∑–‡∫¬’ π

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

«—π∑Ë.’ ................ ®”πÕ߇ªπì ª√–°π— 𓬠°. ∏𓧓√ ‡Õ ›››››› › (≈ß™◊ËÕ)................
‡¥Õ◊ π...............
æ.». ................. °®‘ °“√«‡‘ ∑»∏π°®‘

 “¢“°√ÿ߇∑æœ

«—π∑’.Ë ................ ‡ª≈’ˬπ™◊ËÕºŸâ√—∫ ∏𓧓√ ‡Õ ∏𓧓√ ‡Õ ›››››› › (≈ß™Õ◊Ë )................
‡¥Õ◊ π............... ®”πÕß (√–À«“à ß °®‘ °“√«‡‘ ∑»∏π°®‘
æ.».................. °®‘ °“√∑‡Ë’ ªπì  “¢“°√ßÿ ‡∑æœ

πμ‘ ∫‘ ÿ§§≈‡¥¬’ «°π— )

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