μ«— Õ¬“à ßÀ¡“¬‡≈¢ Û μ“¡√–‡∫¬’ ∫¢Õâ Ò˘ (Ò) «√√§ Õß Û˘˘
(∑.¥. Ò)
∑∫’Ë “â π
°√≥’º∑Ÿâ √ß ∑‘ ∏‡‘ °∫Á °‘π‡ªπì ºâŸ„À‡â ™à“ ·≈–¡’√“¬°“√ ∑ Ë’ «π/‰√à
®¥∑–‡∫¬’ π‡°¬’Ë «°∫— °“√‡™à“μàÕ‡π◊ÕË ß‰ª ∑Ë’π“
∑’Ë..............
§”¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ‘∑∏‘„π∑’Ë¥π‘ ª√–‡¿∑..·..∫...ßà ..·..¬..°...„.π..π...“.¡...‡.¥..¡‘............ ·¬° Ò ·≈–
√μ–”«·“Àß.π..àß..∑..Ë’¥...‘π..............5..1..3..6...I.V....7..2..2..8..›..1......................................... μ”∫≈..........(..§..√..Õ..∫...°..“..√..‡.™..à“..)...................................·..ª...≈..ß..§..ß..‡.À...≈..◊Õ...
‡≈¢∑’¥Ë π‘ .............................Ò........................................................ Õ”‡¿Õ........................................................................................
Ë’∑ ‘¥π·ª≈ß∑’Ë·¬°‰ªπ’È·≈–·ª≈ߧ߇À≈◊Õ°“√‡™à“¬—ߧߡ’Õ à¬Ÿμ“¡ —≠≠“‡™à“∑Ë’¥‘π ©∫—∫≈ß«—π∑’Ë...........‡¥◊Õπ..................æ.». ....Àπ“â ”√«®........................Û..Ù...Ù.....................................................®ß— À«—¥........................................................................................
·≈– —≠≠“‚Õπ ‘∑∏‘°“√‡™à“ ©∫—∫≈ß«—π∑Ë’...........‡ ◊¥Õπ..................æ.». ....
‚©π¥∑¥Ë’ π‘
‡ ⮓æπ—°ß“π Ë’∑¥‘π ‡≈¢∑’Ë.....................Ò..Û..ı...................‡≈à¡............Ò..Ù..........................Àπâ“.....ı...............................
®”π«π∑’Ë¥‘π..............Ú.....................‰√.à ...............›.................ß“π................›...................μ“√“ß«“
Ò. ¢â“懮“⠺⡟ ’π“¡μÕà ‰ªπÈ’ ¡’§«“¡ª√– ߧå¢Õ®¥∑–‡∫’¬π ∑‘ ∏·‘ ≈–πμ‘ ‘°√√¡‡°¬’Ë «°∫— 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‡ªπì §«“¡®√ß‘ „Àâ„™∂â Õâ ¬§”π¬È’ —π¢â“懮“â „π∑“ߧ¥’Õ“≠“‰¥â
Ú. ¢â“懮â“..............π..“..¬...°............................. ‡≈¢ª√–®”μ—«ª√–™“™π ºŸ.â ..∂..◊Õ..°...√..√..¡.. ..∑‘...∏..‘Ï ...............
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Õ“¬ÿ.............ı.....................ªï ≠— ™“μ.‘ ................‰..∑..¬....................∫‘¥“/¡“√¥“™◊ÕË .............................................................................
‚ ¥ 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 ºâŸ...∂..◊Õ...°..√..√..¡.. ...∑‘ ..∏..‘Ï...............
................................................
Õ“¬.ÿ ............Ûı.....................ªï —≠™“μ‘........‰.∑...¬.....‰.∑...¬....................∫¥‘ “/¡“√¥“™◊ËÕ.............................................................................
‚ ¥ 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“â ¢Õ· ¥ß√“§“∑√æ— ¬å∑’Ë¢Õ∑”πμ‘ °‘ √√¡π‡’È ªπì ‡ß‘π........................ı....,.............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à (Àâ“À¡Ë◊π∫“∑∂«â π)
(Ò) ¢“â 懮“â ‰¡à‰¥√â ∫— ‚Õπ·∑πÀ√◊Õ‡æËÕ◊ ª√–‚¬™π·å °à∫§ÿ §≈μ“à ߥ“â «
(Ú) √“§“∑√æ— ¬∑å ’Ë· ¥ß‰«â„π Ù. ‡ªìπ√“§“∑’Ë·∑®â √ß‘
(Û) .·..∫..àß..·...¬..°..„.π...π..“..¡..‡.¥...¡‘ ....(.§..√..Õ...∫..°..“..√..‡.™...à“.)...μ..“..¡...§..”..¢..Õ..≈...ß..«..—π..∑..’.Ë ........‡.¥...Õ◊ ..π.....................æ....»....................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................
«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™◊ÕË .....................π...“.¬....°.........................ºŸâ¢Õ ∂◊Õ°√√¡ ‘∑∏‘Ï
≈ß™◊ËÕ.....................π...“.¬....°..........................ºâŸ¢Õ ∂Õ◊ °√√¡ ‘∑∏‘Ï
≈ß™◊ÕË ......................................................º ⟠Õ∫ «π
(......................................................)
”À√—∫æπ°— ß“π‡®â“Àπâ“∑Ë’
Ò) √“§“ª√–‡¡π‘ ∑πÿ ∑√—æ¬.å ....................................................................................................∫“∑........................................ μ“ߧå
Ú) ‚©π¥∑’Ë¥‘π„À¡à√–«“ß........5..51..13.3.6.6..I.V.I.V...7.72..2..28..8›..›1.1...........‡≈¢∑’Ë¥‘π.................Ò..............................Àπâ“ ”√«®.........Û..ÚÙ...ı...........................
‚©π¥∑Ë¥’ π‘ ‡≈¢∑Ë’....................ˆ..Ú.Ò..ÛÚ..Û.Û..Ò.....................‡≈à¡.......................ˆ.Ò..Û............................Àπâ“.................Û..Û.Ò.Û.............................
®”π«π∑¥’Ë π‘ ...........................Ò..Ò.........................‰√.à .............................›...................ß“π.............................›..›...................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò..Ò.........................‰√.à .............................››...................ß“π.............................›..›...................μ“√“ß«“
Û) ‰¥â®¥∑–‡∫’¬π·≈â«·μ«à π— ∑.Ë’ ................................‡¥◊Õπ............................................æ.»......................
≈ß™◊ËÕ.......................................................
(......................................................)
‡®â“æπ—°ß“π∑Ë’¥‘π
°√≥º’ âŸ∑√ß ∑‘ ∏‘‡°Á∫°π‘ ‡ªπì ºâŸ„Àâ‡™à“ ·≈–¡√’ “¬°“√ μ«— Õ¬à“ßÀ¡“¬‡≈¢ Û μ“¡√–‡∫’¬∫¢Õâ Ò˘ (Ò) «√√§ Õß Ù
®¥∑–‡∫¬’ π‡°Ë’¬«°∫— °“√‡™“à μÕà ‡πÕ◊Ë ß‰ª “√∫—≠®¥∑–‡∫’¬π
(√“¬°“√®¥∑–‡∫’¬π·ª≈߇¥‘¡‚©π¥∑¥’Ë π‘ ‡≈¢∑’Ë ÒÛı)
®¥∑–‡∫¬’ π ª√–‡¿∑°“√ ºâŸ„À â ≠— ≠“ ºŸâ√—∫ —≠≠“ ‡π◊ÈÕ∑’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’ ................ ‘∑∏‡‘ °∫Á °π‘ 𓬠°. 𓬠æ. Ú › › › › › › (≈ß™ÕË◊ ) 𓬠.
ºâ∑Ÿ √ß ‘∑∏‡‘ °∫Á °‘π
‡¥Õ◊ π............... (¡°’ ”Àπ¥ “¡ ∫‘ ªï)
æ.». .................
«—π∑Ë’................. ‡™“à (¡°’ ”Àπ¥ ∫‘ ª)ï 𓬠æ. 𓬠¢. Ú››››› › (≈ß™◊ËÕ) 𓬠.
‡¥Õ◊ π............... ºâ∑Ÿ √ß ∑‘ ∏‡‘ °Á∫°‘π ºŸâ‡™“à
æ.». .................
«π— ∑’Ë................. ‚Õπ ‘∑∏°‘ “√‡™“à 𓬠¢. 𓬠¢. Ú › › › › › › (≈ß™ÕË◊ ) 𓬠.
‡¥Õ◊ π............... ºâ‡Ÿ ™à“ ºâ√Ÿ —∫‚Õπ
æ.». .................
«π— ∑.Ë’ ................ ·∫ßà ·¬°„ππ“¡‡¥¡‘ 𓬠°. 𓬠°. Ú › › › › › 5136 IV 7228-1 (≈ß™Ë◊Õ).........................
‡¥Õ◊ π............... (§√Õ∫°“√‡™“à )
æ.». ................. ∑’¥Ë ‘π·ª≈ß∑·’Ë ¬°‰ªπÈ·’ ≈–·ª≈ߧ߇À≈◊Õ Ò
°“√‡™à“¬ß— §ß¡Õ’ ¬μàŸ “¡ ≠— ≠“‡™“à ∑¥Ë’ π‘ ©∫—∫ ˆÚÛÛ
≈ß«—π∑.’Ë ....‡¥Õ◊ π.........æ.». .... ·≈– —≠≠“‚Õπ
‘∑∏°‘ “√‡™à“ ©∫∫— ≈ß«—π∑.’Ë ....‡¥Õ◊ π.........æ.». ....
°√≥’º∑Ÿâ √ß ∑‘ ∏‡‘ °Á∫°π‘ ‡ªπì ºŸâ„À⇙“à ·≈–¡√’ “¬°“√ μ«— Õ¬à“ßÀ¡“¬‡≈¢ Û μ“¡√–‡∫¬’ ∫¢Õâ Ò˘ (Ò) «√√§ Õß
®¥∑–‡∫¬’ π‡°Ë¬’ «°—∫°“√‡™“à μÕà ‡π◊ÕË ß‰ª “√∫—≠®¥∑–‡∫¬’ π (√“¬°“√®¥·®ßâ ∑¥’Ë π‘ ·ª≈ß∑·Ë’ ¬°‰ª„À¡à ‚©π¥‡≈¢∑Ë’ ˆÚÛÛ)
®¥∑–‡∫¬’ 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◊ ™Õ◊Ë
‚©π¥∑Ë¥’ π‘ „À¡à ª√–∑∫— μ√“
‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
«“ «“
«π— ∑’.Ë ................ ‘∑∏‘‡°Á∫°‘π 𓬠°. 𓬠æ. Ò››››› › (≈ß™ÕË◊ ) 𓬠.
‡¥Õ◊ π............... (¡’°”Àπ¥ “¡ ∫‘ ª)ï ºâ∑Ÿ √ß ‘∑∏‡‘ °Á∫°‘π ‘∑∏‡‘ °∫Á °π‘ ¬—ߧߡՒ ¬Ÿàμ“¡∫π— ∑÷°¢Õâ μ°≈ß «π— ∑’.Ë ......................
æ.».................. (§√Õ∫ ‘∑∏‡‘ °∫Á °‘π) ©∫∫— ≈ß«π— ∑Ë’.......‡¥◊Õπ..................æ.». .... ‡¥◊Õπ....................
æ.». .....................
(≈ß™◊ÕË )................
«—π∑.’Ë ................ ‡™“à (¡’°”Àπ¥ ∫‘ ª)ï 𓬠æ. 𓬠¢. Ò››››› › (≈ß™ÕË◊ ) 𓬠.
‡¥◊Õπ............... (§√Õ∫°“√‡™“à ) º∑⟠√ß ∑‘ ∏‘‡°Á∫°π‘ ºŸ‡â ™à“ °“√‡™à“¬—ߧߡ’Õ¬àŸμ“¡ ≠— ≠“‡™à“∑¥Ë’ π‘ «—π∑.Ë’ ......................
æ.». ................. ©∫—∫≈ß«—π∑Ë’.......‡¥Õ◊ π..................æ.». .... ‡¥Õ◊ π....................
æ.». .....................
(≈ß™ÕË◊ )................
«—π∑.’Ë ................ ‚Õπ ‘∑∏‘°“√‡™à“ 𓬠¢. 𓬠ß. Ò››››› › (≈ß™ËÕ◊ ) 𓬠.
‡¥◊Õπ............... (§√Õ∫°“√‡™à“) º‡Ÿâ ™“à ºŸ√â ∫— ‚Õπ °“√‡™à“¬—ߧߡ’Õ¬àŸμ“¡ ≠— ≠“‚Õπ ∑‘ ∏°‘ “√‡™“à «π— ∑.Ë’ ......................
æ.». ................. ∑’¥Ë ‘π ©∫—∫≈ß«—π∑Ë’.......‡¥◊Õπ..................æ.». .... ‡¥Õ◊ π....................
æ.». .....................
(≈ß™ÕË◊ )................
ÙÒ
ÙÚ
μ—«Õ¬“à ßÀ¡“¬‡≈¢ ÛÒ μ“¡√–‡∫¬’ ∫¢âÕ Ò˘ (Ò) «√√§ Õß (∑.¥. Ò)
∑∫Ë’ “â π
°√≥™’ ËÕ◊ ºâŸ„À‡â ™“à ‡ª≈’ˬπ ·≈–¡’√“¬°“√®¥∑–‡∫’¬π ∑Ë’ «π/‰√à
‡°Ë’¬«°∫— °“√‡™“à μàÕ‡π◊ËÕ߉ª ∑Ë’π“
∑Ë.’ .............
§”¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–πμ‘ ‘°√√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑¥’Ë π‘ ª√–‡¿∑..·..∫...ßà ..·..¬..°...„.π..π...“.¡...‡.¥..¡‘............ ·¬° Ò ·≈–
√μ–”«·“Àß.π..àß..∑..’Ë¥...‘π..............5..1..3..6...I.V....7..2..2..8..›..1.........................................μ”∫≈..........(..§..√..Õ..∫...°..“..√..‡.™..à“..)...................................·..ª...≈..ß..§..ß..‡.À...≈..Õ◊...
‡≈¢∑Ë¥’ π‘ .............................Ò........................................................Õ”‡¿Õ........................................................................................
Ë’∑¥‘π·ª≈ß∑’Ë·¬°‰ªπ’È·≈–·ª≈ߧ߇À≈◊Õ°“√‡™à“ —¬ß§ß¡’Õ¬àŸμ“¡ —≠≠“‡™à“∑Ë’¥‘π ©∫—∫≈ß«—π∑’Ë...........‡ ◊¥Õπ..................æ.». ....Àπ“â ”√«®........................Û..Ù...Ù.....................................................®ß— À«¥— ........................................................................................
·≈– —≠≠“‚Õπ ‘∑∏‘°“√‡™à“ ©∫—∫≈ß«—π∑’Ë...........‡ ◊¥Õπ..................æ.». ....
‚©π¥∑’Ë¥‘π
‡ ⮓æπ—°ß“π Ë’∑¥‘π ‡≈¢∑Ë’.....................Ò..Û..ı...................‡≈à¡............Ò..Ù..........................Àπâ“....ı................................
®”π«π∑’¥Ë π‘ ..............Ú.....................‰√à................›.................ß“π................›...................μ“√“ß«“
Ò. ¢“â 懮“â ºâŸ¡π’ “¡μÕà ‰ªπÈ’ ¡’§«“¡ª√– ߧå¢Õ®¥∑–‡∫¬’ π ‘∑∏·‘ ≈–π‘μ°‘ √√¡‡°Ë¬’ «°∫— Õ —ßÀ“√‘¡∑√æ— ¬∑å °Ë’ ≈“à «¢â“ß∫ππ’È ·≈–
‰¥ªâ Ø‘≠“≥μπ·≈«â ¢Õ„Àâ∂âÕ¬§”¥«â ¬§«“¡ —μ¬å®√ß‘ ∂“â ¢â“懮ⓄÀ∂â âÕ¬§”‰¡‡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 ºâ.Ÿ ..∂..◊Õ..°...√..√..¡.. ..‘∑...∏..Ï‘ ...............
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Õ“¬.ÿ ............ı.....................ªï ≠— ™“μ‘.................‰..∑..¬....................∫¥‘ “/¡“√¥“™Õ◊Ë .............................................................................
‚ ¥ À¡“â ¬ §àŸ ¡√ ™Õ◊Ë ..........................................................................................
Õ¬Ÿà∑’Ë∫“â π/À¡∫àŸ “â π..........................‡≈¢∑Ë.’ ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡Ÿ∑à .’Ë .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®ß— À«—¥.................................À¡“¬‡≈¢‚∑√»—æ∑å.....................
Û. ¢â“懮“â ...............π..“..¬....°........................... ‡≈¢ª√–®”μ—«ª√–™“™π ºâ.Ÿ ..∂..◊Õ...°..√..√..¡.. ...‘∑..∏..Ï‘...............
................................................
Õ“¬.ÿ ............Ûı.....................ªï ≠— ™“μ.‘ .......‰.∑...¬.....‰.∑...¬....................∫¥‘ “/¡“√¥“™◊ÕË .............................................................................
‚ ¥ À¡“â ¬ §Ÿ à ¡√ ™Ë◊Õ....................................................... —≠™“μ‘.......................
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 ....................
Ù. ¢â“懮ⓢշ ¥ß√“§“∑√æ— ¬å∑’¢Ë Õ∑”πμ‘ ‘°√√¡π‡’È ªπì ‡ßπ‘ ........................ı....,.............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à (Àâ“À¡◊Ëπ∫“∑∂â«π)
(Ò) ¢â“懮“â ‰¡à‰¥â√—∫‚Õπ·∑πÀ√◊Õ‡æ◊ËÕª√–‚¬™πå·°∫à ÿ§§≈μà“ߥ⓫
(Ú) √“§“∑√—æ¬å∑Ë·’ ¥ß‰«â„π Ù. ‡ªìπ√“§“∑·Ë’ ∑â®√‘ß
(Û) .·..∫..àß..·..¬...°..„.π...π..“..¡..‡.¥...¡‘ ....(.§..√..Õ...∫..°..“..√..‡.™..à“..)...μ..“..¡...§..”..¢..Õ..≈...ß..«..—π..∑...Ë’ .........‡.¥...Õ◊ ..π.....................æ...»....................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................
«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™Õ◊Ë .....................π...“.¬....°.........................ºŸâ¢Õ ∂◊Õ°√√¡ ‘∑∏Ï‘
≈ß™ËÕ◊ .....................π...“.¬....°..........................ºâŸ¢Õ ∂Õ◊ °√√¡ ‘∑∏‘Ï
≈ß™Ë◊Õ......................................................º ⟠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........5..51..13.3.6.6..I.V.I.V...7.72..2..28..8›..›1.1...........‡≈¢∑¥’Ë ‘π................Ò...............................Àπâ“ ”√«®.........Û..ÚÙ...ı...........................
‚©π¥∑Ë’¥π‘ ‡≈¢∑.Ë’ ...................ˆ..Ú.Ò..ÛÚ..Û.Û..Ò.....................‡≈¡à .......................ˆ.Ò..Û............................Àπ“â .................Û..Û.Ò.Û.............................
®”π«π∑¥Ë’ π‘ ...........................Ò..Ò.........................‰√.à .............................›...................ß“π.............................›..›...................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò..Ò.........................‰√.à .............................››...................ß“π.............................›..›...................μ“√“ß«“
Û) ‰¥®â ¥∑–‡∫’¬π·≈«â ·μ«à π— ∑’Ë.................................‡¥Õ◊ π............................................æ.»......................
≈ß™◊ËÕ.......................................................
(......................................................)
‡®â“æπ—°ß“π∑Ë’¥‘π
°√≥™’ ÕË◊ ºŸâ„À⇙“à ‡ª≈’ˬπ ·≈–¡’√“¬°“√®¥∑–‡∫¬’ π μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÛÒ μ“¡√–‡∫’¬∫¢âÕ Ò˘ (Ò) «√√§ Õß
‡°’¬Ë «°—∫°“√‡™“à μàÕ‡πË◊Õ߉ª “√∫≠— ®¥∑–‡∫’¬π (√“¬°“√®¥∑–‡∫’¬π·ª≈߇¥¡‘ ‚©π¥∑’Ë¥π‘ ‡≈¢∑Ë’ ÒÛı)
®¥∑–‡∫’¬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◊ ™Õ◊Ë
‚©π¥∑Ë¥’ ‘π„À¡à ª√–∑∫— μ√“
‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
«“ «“
«—π∑’Ë................. ‡™à“ (¡°’ ”Àπ¥ ‘∫ª)ï 𓬠°. 𓬠¢. Ú››››› › (≈ß™◊ËÕ) 𓬠.
‡¥◊Õπ............... ºŸâ‡™à“
æ.». .................
«π— ∑Ë’................. ‚Õπ¡√¥° 𓬠°. (ºâμŸ “¬) π“ß π. Ú››››› › (≈ß™ÕË◊ ) 𓬠.
‡¥◊Õπ............... (√–À«à“ß°“√‡™“à )
æ.». .................
«—π∑.’Ë ................ ‚Õπ ∑‘ ∏‘°“√‡™“à 𓬠¢. 𓬠ß. Ú › › › › › › (≈ß™◊ÕË ) 𓬠.
‡¥◊Õπ............... ºŸâ‡™à“ º√⟠—∫‚Õπ
æ.». .................
«π— ∑.Ë’ ................ ·∫àß·¬°„ππ“¡‡¥¡‘ π“ß π. π“ß π. Ò › › Ò › › 5136 IV 7228-1 (≈ß™Ë◊Õ).........................
‡¥Õ◊ π............... (§√Õ∫°“√‡™“à )
æ.». ................. ∑Ë¥’ π‘ ·ª≈ß∑·’Ë ¬°‰ªπ’·È ≈–·ª≈ߧ߇À≈Õ◊ Ò
°“√‡™“à ¬—ߧߡ’Õ¬μŸà “¡ ≠— ≠“‡™à“∑’¥Ë ‘π ©∫—∫ ˆÚÛÛ
≈ß«π— ∑Ë’.....‡¥◊Õπ.........æ.». .... ·≈– —≠≠“‚Õπ
∑‘ ∏‘°“√‡™“à ©∫∫— ≈ß«π— ∑.Ë’ ....‡¥◊Õπ.........æ.». .... ÙÛ
°√≥™’ Ë◊պ⟄Àâ‡™à“‡ª≈’¬Ë π ·≈–¡√’ “¬°“√®¥∑–‡∫¬’ π μ—«Õ¬“à ßÀ¡“¬‡≈¢ ÛÒ μ“¡√–‡∫¬’ ∫¢Õâ Ò˘ (Ò) «√√§ Õß ÙÙ
‡°’ˬ«°∫— °“√‡™“à μàÕ‡π◊ÕË ß‰ª “√∫≠— ®¥∑–‡∫’¬π (√“¬°“√®¥·®âß∑’¥Ë π‘ ·ª≈ß∑Ë’·¬°‰ª„À¡à ‚©π¥‡≈¢∑’Ë ˆÚÛÛ)
®¥∑–‡∫’¬π ª√–‡¿∑°“√ ºŸâ„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◊
‚©π¥∑Ë’¥‘π„À¡à ª√–∑∫— μ√“
‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
«“ «“
«π— ∑Ë.’ ................ ‡™à“ (¡°’ ”Àπ¥ ∫‘ ª)ï 𓬠°. 𓬠¢. Ò››››› › (≈ß™◊ËÕ) 𓬠.
‡¥Õ◊ π............... ºŸ‡â ™à“ °“√‡™à“¬—ߧߡՒ ¬àŸμ“¡ —≠≠“‡™“à ∑¥’Ë ‘π «π— ∑.Ë’ ......................
æ.». ................. ©∫—∫≈ß«—π∑’.Ë ......‡¥Õ◊ π..................æ.». .... ‡¥Õ◊ π....................
æ.». .....................
(≈ß™◊ËÕ)................
«π— ∑.’Ë ................ ‚Õπ¡√¥° (√–À«“à ß π“¬ °. (ºŸâ쓬) π“ß π. Ò››››› › (≈ß™ËÕ◊ ) 𓬠.
‡¥◊Õπ............... °“√‡™à“) °“√‡™“à ¬—ߧߡՒ ¬μŸà “¡ —≠≠“‡™“à ∑’¥Ë π‘ «π— ∑.’Ë ......................
æ.».................. (§√Õ∫°“√‡™“à ) ©∫—∫≈ß«π— ∑’Ë.......‡¥Õ◊ π..................æ.». .... ‡¥◊Õπ....................
æ.». .....................
(≈ß™ÕË◊ )................
«π— ∑Ë.’ ................ ‚Õπ ‘∑∏‘°“√‡™à“ 𓬠¢. 𓬠ß. Ò››››› › (≈ß™ÕË◊ ) 𓬠.
‡¥Õ◊ π............... (§√Õ∫°“√‡™“à ) ºâŸ‡™à“ º√⟠∫— ‚Õπ °“√‡™“à ¬ß— §ß¡’Õ¬μŸà “¡ ≠— ≠“‚Õπ ‘∑∏°‘ “√‡™“à «—π∑Ë.’ ......................
æ.». ................. ∑Ë¥’ π‘ ©∫∫— ≈ß«—π∑’Ë.......‡¥Õ◊ π..................æ.». .... ‡¥◊Õπ....................
æ.». .....................
(≈ß™ËÕ◊ )................
Ùı
μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÛÚ μ“¡√–‡∫¬’ ∫¢âÕ Ò˘ (Ú) (∑.¥. Ò)
∑∫Ë’ “â π
°√≥’·∫ßà ·¬°„ππ“¡‡¥‘¡ „À∫â “ß·ª≈ß¡’°“√‡™“à Õ¬àŸ ∑Ë’ «π/‰√à
∫“ß·ª≈ßæπâ ®“°°“√‡™“à ∑Ë’π“
∑’Ë..............
§”¢Õ®¥∑–‡∫’¬π ‘∑∏·‘ ≈–πμ‘ °‘ √√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ‘∑∏‘„π∑¥Ë’ ‘π ª√–‡¿∑..·..∫...ßà ..·..¬..°...„.π..π...“.¡...‡.¥..¡‘............
μ”·Àπàß∑Ë’¥‘π (§√Õ∫›ª≈Õ¥°“√‡™“à ) ·¬° Ò
√–«“ß........................5..1..3..6...I.V....7..2..2..8..›..1.........................................μ”∫≈.........................................................................................
‡≈¢∑¥’Ë ‘π.............................Ò........................................................Õ”‡¿Õ........................................................................................
Àπâ“ ”√«®........................Û..Ù...Ù.....................................................®—ßÀ«—¥........................................................................................
∑Ë’¥‘π·ª≈ß∑’Ë·¬°‰ªπ’Èæâπ®“°°“√‡™à“μ“¡ —≠≠“‡™à“ ’Ë∑ ‘¥π ©∫—∫≈ß«—π∑Ë’...........‡ ◊¥Õπ..................æ.». ....‚©π¥∑Ë¥’ π‘
μ“¡∫—π∑÷° â¢Õμ°≈ߪ≈Õ¥°“√‡™à“ © —∫∫≈ß«—π∑’Ë...........‡ ◊¥Õπ..................æ.». .... ‡≈¢∑.’Ë ....................Ò..Û..ı...................‡≈¡à ............Ò..Ù..........................Àπ“â ....ı...Ò.............................
‡ ⮓æπ—°ß“π ’Ë∑ ‘¥π ®”π«π∑Ë’¥‘π.............Û..Û....................‰√à..............›...................ß“π...............›....................μ“√“ß«“
Ò. ¢â“懮⓺⟡’π“¡μÕà ‰ªπÈ’ ¡§’ «“¡ª√– ߧ¢å Õ®¥∑–‡∫’¬π ‘∑∏·‘ ≈–πμ‘ ‘°√√¡‡°Ë¬’ «°∫— Õ —ßÀ“√‘¡∑√æ— ¬∑å Ë’°≈“à «¢“â ß∫ππÈ’ ·≈–
‰¥âªØ‘≠“≥μπ·≈â« ¢Õ„Àâ∂âÕ¬§”¥«â ¬§«“¡ —쬮å √ß‘ ∂“â ¢“â 懮“â „À∂â 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 º.⟠..∂..◊Õ..°...√..√..¡.. ..∑‘...∏..‘Ï ...............
.................................................
Õ“¬.ÿ ............ı.....................ªï ≠— ™“μ.‘ ................‰..∑..¬....................∫‘¥“/¡“√¥“™◊ËÕ.............................................................................
‚ ¥ À¡“â ¬ §àŸ ¡√ ™Ë◊Õ..........................................................................................
Õ¬∑Ÿà ∫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 ....................
Û. ¢“â 懮â“...............π..“..¬....°........................... ‡≈¢ª√–®”μ—«ª√–™“™π º.Ÿâ ..∂...◊Õ..°..√..√..¡.. ...‘∑..∏..Ï‘...............
................................................
Õ“¬.ÿ ............Ûı.....................ªï ≠— ™“μ‘........‰.∑...¬.....‰.∑...¬....................∫‘¥“/¡“√¥“™◊ËÕ.............................................................................
‚ ¥ À¡“â ¬ §àŸ ¡√ ™Ë◊Õ....................................................... ≠— ™“μ.‘ ......................
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.....................
Ù. ¢“â 懮ⓢշ ¥ß√“§“∑√—æ¬å∑’Ë¢Õ∑”π‘μ°‘ √√¡π’ȇªπì ‡ßπ‘ ........................ı....,.............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à (À“â À¡◊Ëπ∫“∑∂â«π)
(Ò) ¢â“懮Ⓣ¡à‰¥â√∫— ‚Õπ·∑πÀ√Õ◊ ‡æË◊Õª√–‚¬™πå·°∫à ÿ§§≈μà“ߥ⓫
(Ú) √“§“∑√—æ¬å∑·Ë’ ¥ß‰«â„π Ù. ‡ªìπ√“§“∑Ë·’ ∑â®√ß‘
(Û) .·..∫..àß..·..¬...°..„.π...π..“..¡..‡.¥...¡‘ ....(.§..√..Õ...∫..›..ª..≈...Õ..¥..°...“.√..‡..™..“à ..)..μ...“..¡..§..”..¢..Õ...≈..ß..«..—π..∑...’Ë ........‡..¥..Õ◊ ..π.....................æ...».........................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................
«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™◊ÕË .....................π...“.¬....°.........................ºŸâ¢Õ ∂Õ◊ °√√¡ ∑‘ ∏‘Ï
≈ß™ÕË◊ .....................π...“.¬....°..........................ºâŸ¢Õ ∂◊Õ°√√¡ ‘∑∏Ï‘
≈ß™Õ◊Ë ......................................................º ⟠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........5..51..13..36.6..I.V.I.V...7.72..2..28..8›..›1..1..........‡≈¢∑’¥Ë ‘π.................Ò..............................Àπâ“ ”√«®.........Û..ÚÙ...ı...........................
‚©π¥∑¥Ë’ π‘ ‡≈¢∑.Ë’ ...................ˆ..Ú.Ò..ÛÚ..Û.Û..Ò.....................‡≈à¡.......................ˆ.Ò..Û............................Àπâ“..................Û.Û.Ò.Û.............................
®”π«π∑¥Ë’ π‘ ............................Ò.Ò.........................‰√.à .............................›...................ß“π..............................›.›...................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò..Ú.........................‰√.à .............................››...................ß“π.............................›..›...................μ“√“ß«“
Û) ‰¥®â ¥∑–‡∫’¬π·≈â«·μ«à π— ∑Ë’.................................‡¥◊Õπ............................................æ.»......................
≈ß™◊ÕË .......................................................
(......................................................)
‡®â“æπ—°ß“π∑Ë’¥‘π
Ùˆ
μ—«Õ¬à“ßÀ¡“¬‡≈¢ ÛÚ μ“¡√–‡∫¬’ ∫¢âÕ Ò˘ (Ú) (∑.¥. Ò)
∑∫Ë’ “â π
°√≥·’ ∫àß·¬°„ππ“¡‡¥¡‘ „À∫â “ß·ª≈ß¡°’ “√‡™à“Õ¬àŸ ∑ Ë’ «π/‰√à
∫“ß·ª≈ßæπâ ®“°°“√‡™à“ ∑’Ëπ“
∑.Ë’ .............
§”¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–πμ‘ ‘°√√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑’¥Ë π‘ ª√–‡¿∑..·..∫...ßà ..·..¬..°...„.π..π...“.¡...‡.¥..¡‘............ ·¬° Ú ·≈–
√μ–”«·“Àß.π..àß..∑..’Ë¥...‘π..............5..1..3..6...I.V....7..2..2..8..›..1.........................................μ”∫≈..........(..§..√..Õ..∫...›..ª..≈..Õ...¥..°..“..√..‡.™...à“.).........................·..ª...≈..ß..§...ß.‡..À..≈...◊Õ.
‡≈¢∑Ë’¥π‘ .............................Ò........................................................Õ”‡¿Õ........................................................................................
Àπ“â ”√«®........................Û..Ù...Ù.....................................................®ß— À«¥— ........................................................................................
’∑Ë ‘¥π·ª≈ß∑’Ë·¬°‰ªπÈ’·≈–·ª≈ߧ߇À≈◊Õ°“√‡™à“¬—ߧߡ’Õ¬Ÿàμ“¡ —≠≠“‡™à“∑Ë’¥‘π ©∫—∫≈ß«—π∑’Ë...........‡¥◊Õπ..................æ.». ....‚©π¥∑Ë’¥π‘
‡®â“æπ—°ß“π Ë’∑ ‘¥π ‡≈¢∑.Ë’ ....................Ò..Û..ı...................‡≈à¡............Ò..Ù..........................Àπ“â ....ı................................
®”π«π∑¥Ë’ ‘π.............Û..Ú....................‰√à..............›...................ß“π...............›....................μ“√“ß«“
Ò. ¢â“懮⓺Ÿ¡â π’ “¡μÕà ‰ªπÈ’ ¡’§«“¡ª√– ߧ¢å Õ®¥∑–‡∫’¬π ∑‘ ∏‘·≈–πμ‘ °‘ √√¡‡°¬Ë’ «°—∫Õ ß— À“√‘¡∑√æ— ¬å∑’Ë°≈à“«¢“â ß∫ππ’È ·≈–
‰¥âªØ‘≠“≥μπ·≈â« ¢Õ„À∂â Õâ ¬§”¥â«¬§«“¡ —쬮å √‘ß ∂“â ¢“â 懮ⓄÀ∂â Õâ ¬§”‰¡‡à ªπì §«“¡®√‘ß„Àâ„™∂â Õâ ¬§”πȬ’ π— ¢“â 懮“â „π∑“ߧ¥’Õ“≠“‰¥â
Ú. ¢“â 懮â“..............π..“..¬....°............................ ‡≈¢ª√–®”μ—«ª√–™“™π º.⟠..∂..◊Õ..°...√..√..¡.. ..‘∑...∏..‘Ï ...............
.................................................
Õ“¬ÿ.............ı.....................ªï ≠— ™“μ.‘ ................‰..∑..¬....................∫‘¥“/¡“√¥“™Ë◊Õ.............................................................................
‚ ¥ À¡“â ¬ § àŸ ¡√ ™ËÕ◊ ..........................................................................................
Õ¬Ÿ∑à 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 ....................
Û. ¢â“懮â“...............π..“..¬....°........................... ‡≈¢ª√–®”μ—«ª√–™“™π º.⟠..∂..◊Õ...°..√..√..¡.. ...∑‘ ..∏..‘Ï...............
................................................
Õ“¬.ÿ ............Ûı.....................ªï ≠— ™“μ‘........‰.∑...¬.....‰.∑...¬....................∫‘¥“/¡“√¥“™◊ËÕ.............................................................................
‚ ¥ À¡“â ¬ §à Ÿ ¡√ ™◊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‘°√√¡πȇ’ ªπì ‡ß‘π........................ı....,.............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à (Àâ“À¡◊Ëπ∫“∑∂«â π)
(Ò) ¢â“懮“â ‰¡à‰¥√â —∫‚Õπ·∑πÀ√◊Õ‡æ◊ÕË ª√–‚¬™πå·°∫à ÿ§§≈μ“à ߥ“â «
(Ú) √“§“∑√æ— ¬å∑·’Ë ¥ß‰«â„π Ù. ‡ªìπ√“§“∑Ë’·∑®â √‘ß
(Û) .·..∫..ßà..·..¬...°..„.π...π..“..¡..‡.¥...‘¡....(.§..√..Õ...∫..›..ª..≈...Õ..¥..°...“.√..‡..™..“à ..)..μ...“..¡..§..”..¢..Õ...≈..ß..«..—π..∑...’Ë ........‡..¥..Õ◊ ..π.....................æ...».........................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................
«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™◊ÕË .....................π...“.¬....°.........................ºŸâ¢Õ ∂◊Õ°√√¡ ‘∑∏‘Ï
≈ß™◊ËÕ.....................π...“.¬....°..........................ºŸâ¢Õ ∂Õ◊ °√√¡ ‘∑∏‘Ï
≈ß™ÕË◊ ......................................................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........5..51..13.3.6.6..I.V.I.V...7.72..2..28..8›..›1.1...........‡≈¢∑Ë’¥π‘ .................Ò....Ò..........................Àπâ“ ”√«®.........Û..ÚÙ...ˆ...........................
‚©π¥∑¥Ë’ ‘π‡≈¢∑Ë’....................ˆ..Ú.Ò..ÛÚ..Ù.Û..Ò.....................‡≈à¡.......................ˆ.Ò..Û............................Àπ“â .................Û..Û.Ò.Û.............................
®”π«π∑¥Ë’ π‘ ...........................Ò..Ò.........................‰√.à .............................›...................ß“π.............................›..›...................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò..Ò.........................‰√.à .............................››...................ß“π.............................›..›...................μ“√“ß«“
Û) ‰¥â®¥∑–‡∫¬’ π·≈â«·μ«à —π∑’.Ë ................................‡¥Õ◊ π............................................æ.»......................
≈ß™ËÕ◊ .......................................................
(......................................................)
‡®â“æπ—°ß“π∑’Ë¥‘π
°√≥’·∫ßà ·¬°„ππ“¡‡¥‘¡ „À∫â “ß·ª≈ß¡°’ “√‡™à“Õ¬àŸ μ—«Õ¬“à ßÀ¡“¬‡≈¢ ÛÚ μ“¡√–‡∫¬’ ∫¢Õâ Ò˘ (Ú)
∫“ß·ª≈ßæâπ®“°°“√‡™à“
“√∫—≠®¥∑–‡∫’¬π (√“¬°“√®¥∑–‡∫¬’ π·ª≈߇¥‘¡‚©π¥∑¥’Ë ‘π‡≈¢∑Ë’ ÒÛı)
®¥∑–‡∫¬’ π ª√–‡¿∑°“√ ºŸâ„À â ≠— ≠“ ºâŸ√—∫ —≠≠“ ‡π◊ÈÕ∑Ë’¥‘π ‡π◊ÈÕ∑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’ ................ ‡™à“ (¡’°”Àπ¥ ∫‘ ªï) 𓬠°. 𓬠¢. Û››››› › (≈ß™ËÕ◊ ) 𓬠.
‡¥Õ◊ π............... ºŸâ‡™à“
æ.». .................
«—π∑’Ë................. ·∫ßà ·¬°„ππ“¡‡¥¡‘ 𓬠°. 𓬠°. Ò › › Ú › › 5136 IV 7228-1 (≈ß™ÕË◊ ).........................
‡¥Õ◊ π............... (§√Õ∫›ª≈Õ¥
æ.».................. °“√‡™“à ) ∑Ë¥’ ‘π·ª≈ß∑Ë’·¬°‰ªπæ’È πâ ®“°°“√‡™à“μ“¡ Ò
≠— ≠“‡™à“∑Ë¥’ π‘ ©∫—∫≈ß«—π∑Ë.’ ....‡¥◊Õπ............ ˆÚÛÛ
æ.». .... μ“¡∫—π∑÷°¢âÕμ°≈ߪ≈Õ¥°“√‡™“à
©∫—∫≈ß«π— ∑’Ë.....‡¥Õ◊ π...............æ.». ....
Ò››Ò›› 5136 IV 7228-1 (≈ß™◊ËÕ).........................
∑¥Ë’ π‘ ·ª≈ß∑Ë’·¬°‰ªπ·È’ ≈–·ª≈ߧ߇À≈Õ◊ ÒÒ
°“√‡™“à ¬—ߧߡ’Õ¬μàŸ “¡ —≠≠“‡™à“∑Ë¥’ ‘π ˆÚÛÙ
©∫—∫≈ß«π— ∑Ë’........‡¥◊Õπ............æ.». ....
À¡“¬‡Àμÿ “√∫—≠®¥∑–‡∫¬’ π·ª≈ß·¬° ‚©π¥‡≈¢∑Ë’ ˆÚÛÛ ª≈Õ¥°“√‡™à“ ‰¡àμÕâ ߬°√“¬°“√®¥·®ßâ ·μàÕ¬“à ß„¥ Ù˜
°√≥’·∫àß·¬°„ππ“¡‡¥¡‘ „Àâ∫“ß·ª≈ß¡°’ “√‡™à“Õ¬Ÿà μ—«Õ¬“à ßÀ¡“¬‡≈¢ ÛÚ μ“¡√–‡∫¬’ ∫¢Õâ Ò˘ (Ú) Ù¯
∫“ß·ª≈ßæπâ ®“°°“√‡™“à
“√∫≠— ®¥∑–‡∫¬’ π
(√“¬°“√®¥·®âß∑Ë¥’ π‘ ·ª≈ß∑’Ë·¬°‰ª„À¡à ‚©π¥‡≈¢∑’Ë ˆÚÛÙ)
®¥∑–‡∫’¬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................. ‡™à“ (¡°’ ”Àπ¥ ‘∫ª)ï 𓬠°. 𓬠¢. Ò››››› › (≈ß™Ë◊Õ) 𓬠.
‡¥Õ◊ π............... (§√Õ∫°“√‡™à“) º‡âŸ ™“à °“√‡™à“¬ß— §ß¡’Õ¬μàŸ “¡ ≠— ≠“‡™à“∑Ë’¥π‘ «—π∑.’Ë ............................
æ.». ................. ©∫—∫≈ß«π— ∑’.Ë ......‡¥◊Õπ..................æ.». .... ‡¥Õ◊ π..........................
æ.». ...........................
(≈ß™◊ËÕ)......................
μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÛÛ μ“¡√–‡∫’¬∫¢Õâ Ò˘ (Ú) Ù˘
(∑.¥. Ò)
∑∫’Ë “â π
°√≥·’ ∫àߢ“¬„À·â ª≈ß·¬°æâπ®“°°“√‡™à“ ∑ ’Ë «π/‰√à
·ª≈ߧ߇À≈◊Õ¡°’ “√‡™à“Õ¬Ÿàμ“¡‡¥¡‘ ∑Ë’π“
∑.Ë’ .............
§”¢Õ®¥∑–‡∫¬’ π ∑‘ ∏·‘ ≈–πμ‘ ‘°√√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ‘∑∏‘„π∑Ë’¥π‘ ª√–‡¿∑..·..∫...ßà ..¢..“..¬....(.§..√..Õ...∫..›..ª..≈...Õ..¥..°..“. √‡™“à )
μ”·Àπàß∑Ë’¥‘π
√–«“ß........................5..1..3..6...I.V....7..2..2..8..›..1.........................................μ”∫≈.........................................................................................
‡≈¢∑¥’Ë π‘ .............................˘........................................................Õ”‡¿Õ........................................................................................
Ë’∑¥‘π·ª≈ß∑’Ë·¬°‰ªπ’Èæâπ®“°°“√‡™à“μ“¡ —≠≠“‡™à“ Ë’∑ ‘¥π ©∫—∫≈ß«—π∑Ë’...........‡¥◊Õπ..................æ.». .... Àπ“â ”√«®........................Ú...¯.......................................................®—ßÀ«¥— ........................................................................................
μ“¡∫—π∑÷°¢âÕμ°≈ߪ≈Õ¥°“√‡™à“ ©∫—∫≈ß«—π∑Ë’...........‡¥◊Õπ..................æ.». .... à «π·ª≈ߧ߇À≈◊Õ°“√‡™à“ —¬ß§ß¡’Õ à¬Ÿμ“¡‡¥‘¡
‚©π¥∑¥’Ë ‘π
‡®â“æπ—°ß“π ’Ë∑ ‘¥π ‡≈¢∑’.Ë ....................Ò..Û..ı...................‡≈à¡............Ò..Ù..........................Àπ“â ....ı................................
®”π«π∑Ë’¥π‘ .............Û..Ú....................‰√.à .............›...................ß“π...............›....................μ“√“ß«“
Ò. ¢“â 懮“â º¡âŸ π’ “¡μÕà ‰ªπ’È ¡’§«“¡ª√– ߧå¢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“â „À∂â âÕ¬§”‰¡à‡ªì𧫓¡®√‘ß„Àâ„™∂â âÕ¬§”π¬’È —π¢“â 懮Ⓞπ∑“ߧ¥Õ’ “≠“‰¥â
Ú. ¢“â 懮“â ..............π..“..¬...°............................. ‡≈¢ª√–®”μ—«ª√–™“™π º.⟠..¢..“..¬...............................
.................................................
Õ“¬.ÿ ............ı.....................ªï —≠™“μ.‘ ................‰..∑..¬....................∫‘¥“/¡“√¥“™◊ÕË .............................................................................
‚ ¥ À¡“â ¬ §Ÿà ¡√ ™ËÕ◊ ..........................................................................................
Õ¬à∑Ÿ 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 º.Ÿâ ..´..È◊Õ.................................
................................................
Õ“¬ÿ............Û.ı.....................ªï —≠™“μ.‘ .......‰.∑...¬.....‰.∑...¬....................∫‘¥“/¡“√¥“™◊ÕË .............................................................................
‚ ¥ À¡“â ¬ §Ÿà ¡√ ™ÕË◊ ....................................................... ≠— ™“μ‘.......................
Õ¬à∑Ÿ ’∫Ë â“π/À¡Ÿ∫à 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’ȇªπì ‡ßπ‘ ........................ı....,.............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à (À“â À¡Ëπ◊ ∫“∑∂â«π)
(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. ‡ªπì √“§“∑·Ë’ ∑â®√ß‘
(Û) .‰.¡..¡à... ’ ..ßË‘ ..ª..≈...Ÿ°.. ..√..â“..ß.............................................................................................................................................
(Ù) .º..⟢..“..¬..‰.¥...∑â ..’¥Ë...π‘ ..¡..“..‚.¥...¬...............................................‡..ª..ìπ..‡..«..≈..“........................ª...ï .‰..¡..§à ..â“..ß..™..”..√..–..¿...“.…...’∫..”..√..ÿß..∑..âÕ...ß..∑..’Ë...............................................
(ı) .º..¢âŸ ..“..¬..‰..¥..â√..—∫..™..”..√..–..√..“..§...“.∑...’Ë¥..‘π..§...√..∫..∂..â«..π...·..≈..â«...........................................................................................................
«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™Ë◊Õ.....................π...“.¬....°.........................ºŸâ¢Õ ¢“¬
≈ß™Ë◊Õ.....................π...“.¬....§..........................ºŸâ¢Õ ´◊ÈÕ
≈ß™Ë◊Õ......................................................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........5..51..13..36.6..I.V.I.V...7.72..2..28..8›..›1..1..........‡≈¢∑’¥Ë ‘π.................Ò..............................Àπ“â ”√«®.........Ú..Ú.˘.............................
‚©π¥∑’¥Ë π‘ ‡≈¢∑Ë’....................Ò..Û.Ò.ı.Ú..Ò.Û..Ò.....................‡≈¡à ........................Ò..ÙÛ............................Àπâ“..................Û.ı.Ò.Ò.............................
®”π«π∑¥’Ë π‘ ............................Ò.Ò.........................‰√.à .............................›...................ß“π..............................›.›...................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò..Ò.........................‰√.à .............................››...................ß“π.............................›..›...................μ“√“ß«“
Û) ‰¥®â ¥∑–‡∫’¬π·≈«â ·μà«—π∑Ë’.................................‡¥Õ◊ π............................................æ.»......................
≈ß™◊ËÕ.......................................................
(......................................................)
‡®â“æπ—°ß“π∑Ë’¥‘π
ÙÒ (∑.¥. Òˆ)
μ—«Õ¬à“ßÀ¡“¬‡≈¢ ÛÛ μ“¡√–‡∫¬’ ∫¢Õâ Ò˘ (Ú)
°√≥·’ ∫àߢ“¬„Àâ·ª≈ß·¬°æπâ ®“°°“√‡™à“
·ª≈ߧ߇À≈◊Õ¡’°“√‡™à“Õ¬Ÿàμ“¡‡¥¡‘
∫π— ∑°÷ ¢Õâ μ°≈ߪ≈Õ¥°“√‡™à“
∑Ë’¥‘π
√–«“ß.............5..15.3.1.6.3..6.I.V.I.V..7..27..2..82..›8.1.›..1........................................μ”∫≈........................................................................
‡≈¢∑¥’Ë π‘ ................˘.Ú...Û...........Àπ“â ”√«®........Ú..Ù.¯.Ù................Õ”‡¿Õ.......................................................................
‚©π¥À¡“¬‡≈¢∑.Ë’ .........Ò...Û..ı..Û...˘..Ò.........................................®—ßÀ«—¥.......................................................................
∑’«Ë à“°“√.....................................................................
«—π∑’.Ë ...............‡¥Õ◊ π........................................æ.».....................
¢“â 懮“â .....................π..“..¬....¢.......º..Ÿâ‡..™..“à ........................................................ ‡≈¢ª√–®”μ—«ª√–™“™π
.....................π..“..¬....°........º..âŸ.„.À..‡â..™..“à ....................................................
Õ“¬.ÿ ..ı.....,..Û.........ªï ‡™ÕÈ◊ ™“μ.‘ .............................. —≠™“μ.‘ .......‰..∑..¬..,...‰.∑..¬...........∫‘¥“/¡“√¥“™◊ÕË ............................................................
Õ¬∑Ÿà 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//ª//Ø//‘≠//“/≥///μ//π//·/≈//–//„/À//∂â //Õâ //¬/§//”//μ/Õà//.....‰..¥..â∑...”.∫...—π..∑..÷°...¢..Õâ ..μ...°..≈..ß..μ..àÕ...‡.®..“â..æ..π...—°..ß..“..π..∑...¥Ë’ ..‘π.....................................................................................
¥//«â//¬//§//«/“/¡// //μ—//¬//å®/√//ß‘ / ¥ß— μàÕ‰ªπÈ’ :›
......................∑...’¥Ë ..‘π...·..ª..≈...ß..‡.§...√..◊ËÕ...ß..À..¡...“..¬..¢..“â..ß..∫...π..π...’È.¢...“â ..æ..‡..®..“â ..∑..Èß—.. ...Õ..ß...Ω..“É..¬..‰..¥..μâ...°..≈...ß..°..—π...®..¥..∑...–..‡.∫...’¬..π...‡.™...à“.‰..«..μâ..Õà...°..π—....μ...“..¡.. ...≠— ...≠....“.‡..™..à“..∑...¥Ë’ ..‘π....©...∫..∫—.........
.≈..ß..«..—π...∑...Ë’......‡..¥..◊Õ...π................æ.....»..............∫...¥— ..π...È’ .π...“..¬....°.....º...Ÿâ„.À...‡â.™...“à ..‰.¥...â·..∫..ßà...¢..“..¬..∑...’Ë¥..‘π...·..·..ª...≈..ß...π..È’„..À..â·...°..à.π...“..¬....§......‚.¥...¬..∑..’Ë¥...‘π.. ...«à..π..·...∫..ßà...·..¬..°...‰.ª...‡.ª...πì ..‚.©...π..¥...∑..¥’Ë...π‘..„..À..¡...à
.‡.≈..¢...∑...Ë’.........Ò......Û.....ı.....Ò........................................¢..“â..æ...‡.®...â“..∑..—Èß.. ...Õ..ß..Ω...“É ..¬..‰..¥..âμ...°..≈..ß...¬..π‘..¬...Õ..¡...„.À...â∑..¥’Ë...π‘ ..‡..©..æ...“..–.. ..à«..π...∑..·Ë’...∫..ßà..·...¬..°..Õ...Õ..°...‰.ª...‡.ª...ìπ..‚..©..π..¥...„.À...¡..‡à..≈..¢...∑..Ë.’........Ò.....Û.....ı......Ò...................................
æ...âπ...®..“..°..°..“..√...‡.™..“à..‰..ª.... ..«à..π...‚.©...π..¥..∑...¥Ë’...‘π..·..ª...≈..ß..§...ß..‡..À..≈..◊Õ...¬..—ß...§..ß..¡...°’ ..“..√..‡.™...à“..Õ..¬...àμŸ ..“..¡... ..—≠...≠....“..‡.™..“à..∑...¥Ë’ ..‘π...μ..“..¡...‡.¥...‘¡..............................................................
......................∫...π— ..∑...°÷ ..¢..Õâ...μ..°...≈..ß..π...’∑È ..”..‰..«..Àâ ..π...Ë÷ß..©..∫...—∫....‡.°...∫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◊...™..◊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...™..◊ËÕ...........................................................π......“....¬.........¢......................................................º..⟇..™..à“............................................
............................................................................................≈..ß...™..◊ËÕ...........................................................π......“....¬.........°......................................................º..Ÿâ.„.À...‡â .™..“à........................................
............................................................................................≈..ß...™..Ë◊Õ....................................................................................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..◊ËÕ.....................................................................................................................................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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°√≥’·∫àߢ“¬„Àâ·ª≈ß·¬°æâπ®“°°“√‡™“à μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÛÛ μ“¡√–‡∫’¬∫¢Õâ Ò˘ (Ú)
·ª≈ߧ߇À≈◊Õ¡°’ “√‡™“à Õ¬Ÿàμ“¡‡¥‘¡
“√∫—≠®¥∑–‡∫¬’ π (√“¬°“√®¥∑–‡∫¬’ π·ª≈߇¥‘¡‚©π¥∑Ë¥’ π‘ ‡≈¢∑Ë’ ÒÛı)
®¥∑–‡∫’¬π ª√–‡¿∑°“√ ºŸâ„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................. ‡™“à (¡°’ ”Àπ¥ ‘∫ª)ï 𓬠°. 𓬠¢. Ú››››› › (≈ß™Ë◊Õ) 𓬠æ.
‡¥Õ◊ π............... ºâŸ‡™à“
æ.». .................
«—π∑’Ë................. ·∫ßà ¢“¬ 𓬠°. 𓬠§. Ò › › Ò › › 5316 IV 7228-1 (≈ß™Ë◊Õ).........................
‡¥◊Õπ............... (§√Õ∫›ª≈Õ¥
æ.».................. °“√‡™“à ) ∑¥Ë’ π‘ ·ª≈ß∑’Ë·¬°‰ªπÈ’æâπ®“°°“√‡™“à μ“¡ Ò
≠— ≠“‡™“à ∑’Ë¥π‘ ©∫∫— ≈ß«—π∑.Ë’ ....‡¥◊Õπ............ ÒÛıÒ
æ.». .... μ“¡∫—π∑°÷ ¢Õâ μ°≈ߪ≈Õ¥°“√‡™“à
©∫—∫≈ß«π— ∑Ë’.........‡¥Õ◊ π......................æ.». ....
à«π·ª≈ߧ߇À≈Õ◊ °“√‡™à“¬—ߧߡ’Õ¬àŸ‡¥‘¡
À¡“¬‡Àμÿ “√∫—≠®¥∑–‡∫’¬π·ª≈ß·¬° ‚©π¥‡≈¢∑’Ë ÒÛıÒ ª≈Õ¥°“√‡™“à ‰¡μà âÕ߬°√“¬°“√®¥·®âß·μÕà ¬“à ß„¥ ÙÒÒ
ÙÒÚ
μ«— Õ¬“à ßÀ¡“¬‡≈¢ ÛÙ μ“¡√–‡∫¬’ ∫¢Õâ Ò˘ (Û) «√√§ÀπßË÷ (∑.¥. Ò)
∑∫’Ë “â π
·∫ßà °√√¡ ∑‘ ∏√‘Ï «¡„À·â ª≈ß·¬°‡ªπì ¢ÕߺŸâ∂Õ◊ °√√¡ ‘∑∏Ï‘ ∑ Ë’ «π/‰√à
∑’ˉ¡à‰¥â„À‡â ™“à /·ª≈ߧ߇À≈Õ◊ ‡ªπì à«π¢ÕߺŸâ„À‡â ™“à ∑’Ëπ“
∑’Ë..............
§”¢Õ®¥∑–‡∫¬’ π ‘∑∏‘·≈–π‘μ‘°√√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑¥’Ë π‘ ª√–‡¿∑..·..∫...ßà ..°..√..√..¡.. ...∑‘ ..∏..‘Ï√..«..¡.............
μ”·Àπàß∑’Ë¥‘π (§√Õ∫°“√‡™à“) ·¬° Ò
√–«“ß........................5..1..3..6...I.V....7..2..2..8..›..1......................................... μ”∫≈.........................................................................................
‡≈¢∑Ë’¥‘π.............................˘........................................................ Õ”‡¿Õ........................................................................................
Àπâ“ ”√«®........................Ò..˘........................................................®ß— À«¥— ........................................................................................
’∑Ë¥‘π·ª≈ß∑Ë’·¬°‰ªπ’ȉ¡à¡’°“√‡™à“§√Õ∫μ‘¥Õ¬Ÿàμ“¡ —≠≠“‡™à“ ’∑Ë¥‘π‡©æ“– à«π ©∫—∫≈ß«—π∑’Ë...........‡¥◊Õπ..................æ.». .... ·μàÕ à¬“ß„¥‚©π¥∑’¥Ë π‘
‡®â“æ —π°ß“π Ë’∑¥‘π ‡≈¢∑Ë’.....................Ò..Ú...Û..................‡≈¡à ............Ò..Û..........................Àπ“â ....Û................................
®”π«π∑¥Ë’ π‘ .............Û..Ú....................‰√.à .............›...................ß“π...............›....................μ“√“ß«“
Ò. ¢“â 懮⓺Ÿâ¡’π“¡μàÕ‰ªπ’È ¡§’ «“¡ª√– ߧ¢å Õ®¥∑–‡∫’¬π ∑‘ ∏·‘ ≈–π‘μ°‘ √√¡‡°’¬Ë «°—∫Õ —ßÀ“√‘¡∑√—æ¬å∑’°Ë ≈“à «¢â“ß∫ππ’È ·≈–
‰¥âªØ≠‘ “≥μπ·≈«â ¢Õ„Àâ∂âÕ¬§”¥«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 ..............Ò.....π..“..¬....°........................ ‡≈¢ª√–®”μ—«ª√–™“™π º.Ÿâ ..∂..◊Õ..°...√..√..¡.. ..‘∑...∏..‘Ï ...............
.............Ú......π..“..¬....§........................
Õ“¬ÿ...........Û....,...Ù...ı.............ªï —≠™“μ.‘ ................‰..∑..¬....................∫¥‘ “/¡“√¥“™◊ÕË .............................................................................
‚ ¥ À¡“â ¬ §Ÿ à ¡√ ™Õ◊Ë ..........................................................................................
Õ¬Ÿ∑à ∫Ë’ â“π/À¡Ÿ∫à 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 ..∂..◊Õ...°..√..√..¡.. ...∑‘ ..∏..Ï‘...............
................................................
Õ“¬.ÿ .........Ù..ı.ı.....................ªï ≠— ™“μ‘........‰.∑...¬.....‰.∑...¬....................∫¥‘ “/¡“√¥“™Ë◊Õ.............................................................................
‚ ¥ À¡“â ¬ § àŸ ¡√ ™Ë◊Õ....................................................... —≠™“μ.‘ ......................
Õ¬Ÿ∑à ’∫Ë â“π/À¡Ÿà∫“â π..........................‡≈¢∑’.Ë ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡∑Ÿà Ë.’ .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«¥— .................................À¡“¬‡≈¢‚∑√»æ— ∑.å ....................
Ù. ¢“â 懮ⓢշ ¥ß√“§“∑√æ— ¬å∑Ë’¢Õ∑”π‘μ°‘ √√¡πȇ’ ªìπ‡ß‘π........................ı....,.............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à (À“â À¡◊Ëπ∫“∑∂«â π)
(Ò) ¢“â 懮“â ‰¡à‰¥√â —∫‚Õπ·∑πÀ√◊Õ‡æË◊Õª√–‚¬™π·å °à∫ÿ§§≈μ“à ߥ⓫
(Ú) √“§“∑√—æ¬å∑Ë·’ ¥ß‰«â„π Ù. ‡ªπì √“§“∑’·Ë ∑â®√‘ß
(Û) .·..∫..àß..°..√..√..¡... ..‘∑..∏...‘√Ï ..«..¡...μ...“..¡..§..”..¢..Õ...©..∫..—∫...≈..ß..«..—π..∑...Ë’ ........‡..¥..Õ◊..π....................æ...».......................................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................
«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™Õ◊Ë .....................π...“.¬....°.........................ºâŸ¢Õ ∂Õ◊ °√√¡ ‘∑∏‘Ï
≈ß™◊ËÕ.....................π...“.¬....§..........................ºŸâ¢Õ ∂◊Õ°√√¡ ∑‘ ∏‘Ï
≈ß™◊ËÕ......................................................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........5..51..13.3.6.6..I.V.I.V..7..72..2..28..8›..›1.1...........‡≈¢∑¥Ë’ π‘ .................Ò..............................Àπ“â ”√«®.........Ú..Ú..............................
‚©π¥∑’Ë¥‘π‡≈¢∑.Ë’ ...................Ò..Ú.Ò..ÛÚ..Ò.Û..Ò.....................‡≈à¡........................Ò..Û............................Àπâ“.................Û..Û.Ò.Ò.............................
®”π«π∑¥Ë’ π‘ ...........................Ò..Ò.........................‰√.à .............................›...................ß“π.............................›..›...................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò..Ò.........................‰√.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¡“¬‡≈¢ ÛÙ μ“¡√–‡∫’¬∫¢Õâ Ò˘ (Û) «√√§Àπ÷ßË ÙÒÛ
(∑.¥. Ò)
∑∫’Ë “â π
·∫ßà °√√¡ ‘∑∏‘√Ï «¡„Àâ·ª≈ß·¬°‡ªπì ¢Õߺ∂⟠Õ◊ °√√¡ ∑‘ ∏Ï‘ ∑Ë ’ «π/‰√à
∑’ˉ¡à‰¥â„À⇙“à /·ª≈ߧ߇À≈◊Õ‡ªìπ à«π¢ÕߺŸâ„À⇙“à ∑’Ëπ“
∑’Ë..............
§”¢Õ®¥∑–‡∫’¬π ∑‘ ∏·‘ ≈–π‘μ‘°√√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑’Ë¥π‘ ª√–‡¿∑..·..∫...ßà ..°..√..√..¡.. ...∑‘ ..∏..√‘Ï..«..¡.............
μ”·Àπàß∑Ë’¥‘π (§√Õ∫°“√‡™à“) ·ª≈ߧ߇À≈◊Õ
√–«“ß........................5..1..3..6...I.V....7..2..2..8..›..1......................................... μ”∫≈.........................................................................................
‡≈¢∑Ë’¥π‘ .............................˘........................................................ Õ”‡¿Õ........................................................................................
Àπ“â ”√«®........................Ò..˘........................................................®ß— À«¥— ........................................................................................
’∑Ë¥‘π·ª≈ߧ߇À≈◊Õ°“√‡™à“¬—ߧߡ’Õ¬Ÿàμ“¡ —≠≠“‡™à“ Ë’∑ ‘¥π‡©æ“– à«π ©∫—∫≈ß«—π∑Ë’...........‡ ◊¥Õπ..................æ.». ....‚©π¥∑Ë’¥π‘
‡®â“æπ—°ß“π Ë’∑ ‘¥π ‡≈¢∑’.Ë ....................Ò..Ú...Û..................‡≈¡à ............Ò..Û..........................Àπ“â ....Û................................
®”π«π∑Ë¥’ ‘π.............Û..Ò....................‰√à..............›...................ß“π...............›....................μ“√“ß«“
Ò. ¢“â 懮⓺Ÿâ¡’π“¡μàÕ‰ªπÈ’ ¡’§«“¡ª√– ߧå¢Õ®¥∑–‡∫’¬π ‘∑∏·‘ ≈–π‘μ‘°√√¡‡°Ë’¬«°—∫Õ —ßÀ“√¡‘ ∑√—æ¬∑å °’Ë ≈à“«¢“â ß∫ππÈ’ ·≈–
‰¥ªâ Ø≠‘ “≥μπ·≈«â ¢Õ„À∂â Õâ ¬§”¥«â ¬§«“¡ —쬮å √‘ß ∂â“¢“â 懮“â „À∂â âÕ¬§”‰¡à‡ªπì §«“¡®√‘ß„Àâ„™∂â Õâ ¬§”π¬È’ π— ¢“â 懮Ⓞπ∑“ߧ¥’Õ“≠“‰¥â
Ú. ¢“â 懮“â ..............Ò.....π..“..¬....°........................ ‡≈¢ª√–®”μ—«ª√–™“™π º.Ÿâ ..∂..◊Õ..°...√..√..¡.. ..∑‘...∏..Ï‘ ...............
.............Ú......π..“..¬....§........................
Õ“¬ÿ...........Û....,...Ù...ı.............ªï —≠™“μ.‘ ................‰..∑..¬....................∫‘¥“/¡“√¥“™Õ◊Ë .............................................................................
‚ ¥ À¡“â ¬ §àŸ ¡√ ™◊ËÕ..........................................................................................
Õ¬Ÿ∑à 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 ....................
Û. ¢“â 懮â“...............π..“..¬....°........................... ‡≈¢ª√–®”μ—«ª√–™“™π ºŸâ...∂..Õ◊...°..√..√..¡.. ...‘∑..∏..Ï‘...............
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Õ“¬.ÿ .........Û...ı.....................ªï ≠— ™“μ.‘ .......‰.∑...¬.....‰.∑...¬....................∫¥‘ “/¡“√¥“™Õ◊Ë .............................................................................
‚ ¥ À¡“â ¬ §àŸ ¡√ ™ËÕ◊ ....................................................... ≠— ™“μ.‘ ......................
Õ¬∑àŸ ∫’Ë â“π/À¡∫Ÿà â“π..........................‡≈¢∑’.Ë ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡àŸ∑’.Ë .............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«¥— .................................À¡“¬‡≈¢‚∑√»—æ∑å.....................
Ù. ¢“â 懮“â ¢Õ· ¥ß√“§“∑√—æ¬∑å Ë’¢Õ∑”πμ‘ ‘°√√¡π‡È’ ªπì ‡ß‘π........................ı....,.............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à (Àâ“À¡πË◊ ∫“∑∂«â π)
(Ò) ¢â“懮“â ‰¡à‰¥â√∫— ‚Õπ·∑πÀ√◊Õ‡æ◊ËÕª√–‚¬™π·å °à∫§ÿ §≈μà“ߥ“â «
(Ú) √“§“∑√—æ¬∑å ·’Ë ¥ß‰«â„π Ù. ‡ªìπ√“§“∑Ë·’ ∑®â √‘ß
(Û) .·..∫..ßà..°...√..√..¡.. ..‘∑...∏..Ï√‘ ..«..¡...μ...“..¡..§..”..¢..Õ...©..∫..∫—...≈..ß..«..—π..∑...Ë’ ........‡..¥..◊Õ..π....................æ...».......................................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................
«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™Ë◊Õ.....................π...“.¬....§.........................ºŸâ¢Õ ∂Õ◊ °√√¡ ‘∑∏‘Ï
≈ß™◊ÕË .....................π...“.¬....°..........................ºâŸ¢Õ ∂Õ◊ °√√¡ ∑‘ ∏‘Ï
≈ß™ËÕ◊ ......................................................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..........5..1.3..›6....I.V....7..2..2..8..›.1...........‡≈¢∑Ë¥’ π‘ .................›Ò..............................Àπâ“ ”√«®.........›..Ú..............................
‚©π¥∑’¥Ë π‘ ‡≈¢∑.Ë’ .....................›.Ò..Ú...Û..Ò.....................‡≈¡à ........................›Ò..Û............................Àπâ“.................Û..›.Ò..............................
®”π«π∑¥’Ë π‘ ...........................Ò..›.........................‰√.à .............................›...................ß“π.............................›..›...................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò..›.........................‰√.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¡“¬‡≈¢ ÛÙ μ“¡√–‡∫¬’ ∫¢Õâ Ò˘ (Û) «√√§ÀπËß÷ ÙÒÙ
·∫ßà °√√¡ ∑‘ ∏‘√Ï «¡„Àâ·ª≈ß·¬°‡ªìπ¢ÕߺŸâ∂Õ◊ °√√¡ ∑‘ ∏‘Ï “√∫—≠®¥∑–‡∫¬’ π
∑’ˉ¡à‰¥â„À⇙“à /·ª≈ߧ߇À≈Õ◊ ‡ªìπ à«π¢Õߺ⟄À⇙“à (√“¬°“√®¥∑–‡∫’¬π·ª≈߇¥¡‘ ‚©π¥‡≈¢∑Ë’ ÒÚÛ)
®¥∑–‡∫¬’ π ª√–‡¿∑°“√ ºâŸ„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
‚©π¥∑Ë’¥‘π„À¡à ª√–∑∫— μ√“
‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
«“ «“
«—π∑Ë’................. ‡™à“‡©æ“– «à π Ò. 𓬠°. 𓬠¢. Ú››››› › (≈ß™◊ÕË ) 𓬠æ.
‡¥◊Õπ............... (¡°’ ”Àπ¥ ∫‘ ª)ï Ú. 𓬠§. ºŸâ‡™à“ 𓬠°. „À⇙à“∑¥Ë’ π‘ ‡©æ“– à«π¢Õßμπ·°à
æ.». ................. 𓬠¢. «à π¢Õß∫§ÿ §≈Õ◊Ëπ§ß‡¥¡‘
«—π∑’Ë................. ·∫àß°√√¡ ∑‘ ∏‘Ï√«¡ Ò. 𓬠°. 𓬠§. Ò › › Ò › › 5136 IV 7228-1 (≈ß™Õ◊Ë ).........................
‡¥Õ◊ π............... (§√Õ∫°“√‡™“à ) Ú. 𓬠§.
æ.». ................. ∑’Ë¥π‘ ·ª≈ß∑Ë·’ ¬°‰ªπÈ’ ‰¡à¡°’ “√‡™“à §√Õ∫쥑 Õ¬àŸ Ò
μ“¡ —≠≠“‡™“à ∑Ë¥’ π‘ ‡©æ“– à«π ©∫—∫≈ß«—π∑’Ë.... ÒÚÛÒ
‡¥Õ◊ π...................æ.». .... ·μÕà ¬à“ß„¥
𓬠°. Ò››››› › (≈ß™ËÕ◊ ).........................
∑Ë¥’ ‘π·ª≈ߧ߇À≈Õ◊ °“√‡™“à ¬—ߧߡՒ ¬Ÿàμ“¡
—≠≠“‡™“à ∑Ë’¥π‘ ‡©æ“– à«π ©∫—∫≈ß«π— ∑’.Ë .......
‡¥◊Õπ...........................æ.». ....
À¡“¬‡Àμÿ “√∫≠— ®¥∑–‡∫¬’ π·ª≈ß·¬° ‚©π¥‡≈¢∑Ë’ ÒÚÛÒ ‰¡¡à ’°“√‡™“à §√Õ∫쥑 Õ¬àŸ‰¡μà âÕ߬°√“¬°“√®¥·®ßâ ·μàÕ¬“à ß„¥
μ—«Õ¬“à ßÀ¡“¬‡≈¢ Ûı μ“¡√–‡∫’¬∫¢âÕ Ò˘ (Û) «√√§ Õß ÙÒı
(∑.¥. Ò)
∑∫Ë’ “â π
·∫ßà °√√¡ ‘∑∏√‘Ï «¡ °√≥·’ ª≈ß·¬°‡ªìπ¢Õߺ⟄À‡â ™“à ∑Ë ’ «π/‰√à
∑’Ëπ“
∑.’Ë .............
§”¢Õ®¥∑–‡∫’¬π ∑‘ ∏·‘ ≈–π‘μ°‘ √√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ‘∑∏‘„π∑’¥Ë ‘π ª√–‡¿∑..·..∫...àß..°..√..√..¡.. ...‘∑..∏..√‘Ï..«..¡.............
μ”·Àπàß∑’Ë¥‘π (§√Õ∫°“√‡™à“) ·¬° Ò
√–«“ß........................5..1..3..6...I.V....7..2..2..8..›..1.........................................μ”∫≈.........................................................................................
‡≈¢∑Ë’¥π‘ .............................Ú..Û......................................................Õ”‡¿Õ........................................................................................
Àπâ“ ”√«®........................Ù..Ù...Ù.....................................................®ß— À«¥— ........................................................................................
’∑Ë¥‘π·ª≈ß∑Ë’·¬°‰ªπ’È°“√‡™à“¬—ߧߡ’Õ¬Ÿàμ“¡ —≠≠“‡™à“ ’Ë∑ ‘¥π‡©æ“– à«π ©∫—∫≈ß«—π∑’Ë...........‡ ◊¥Õπ..................æ.». ....‚©π¥∑¥’Ë π‘
‡®â“æπ—°ß“π Ë’∑¥‘π ‡≈¢∑.’Ë ....................ı..Û..˘...Ò................‡≈¡à ............ı..Ù..........................Àπâ“....˘...Ò.............................
®”π«π∑’¥Ë π‘ .............Û..Ú....................‰√à..............Û...................ß“π...............ı....................μ“√“ß«“
Ò. ¢â“懮⓺⡟ π’ “¡μÕà ‰ªπÈ’ ¡’§«“¡ª√– ߧ¢å Õ®¥∑–‡∫¬’ π ‘∑∏·‘ ≈–πμ‘ ‘°√√¡‡°’ˬ«°∫— Õ ß— À“√‘¡∑√æ— ¬∑å °Ë’ ≈“à «¢“â ß∫ππ’È ·≈–
‰¥ªâ Ø≠‘ “≥μπ·≈â« ¢Õ„À∂â Õâ ¬§”¥«â ¬§«“¡ —μ¬å®√ß‘ ∂“â ¢“â 懮ⓄÀâ∂âÕ¬§”‰¡à‡ªπì §«“¡®√ß‘ „Àâ„™∂â âÕ¬§”π’È¬π— ¢“â 懮Ⓞπ∑“ߧ¥Õ’ “≠“‰¥â
Ú. ¢â“懮â“.............Ò......π..“..¬....°........................ ‡≈¢ª√–®”μ—«ª√–™“™π ºŸ.â ..∂..◊Õ..°...√..√..¡.. ..‘∑...∏..‘Ï ...............
Ú. 𓬠§.
.............Û.....π...“.¬....ß... .....................
Õ“¬ÿ...........Û....,...Ù...ı.............ªï —≠™“μ.‘ ................‰..∑..¬....................∫¥‘ “/¡“√¥“™ËÕ◊ .............................................................................
‚ ¥ À¡“â ¬ §àŸ ¡√ ™◊ÕË ..........................................................................................
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.....................
Û. ¢â“懮â“...............π..“..¬....°........................... ‡≈¢ª√–®”μ—«ª√–™“™π º.⟠..∂...◊Õ..°..√..√..¡.. ...‘∑..∏..‘Ï...............
................................................
Õ“¬ÿ..........Ù..ı.ı.....................ªï ≠— ™“μ‘........‰.∑...¬.....‰.∑...¬....................∫¥‘ “/¡“√¥“™◊ËÕ.............................................................................
‚ ¥ À¡“â ¬ §à Ÿ ¡√ ™Õ◊Ë ....................................................... ≠— ™“μ‘.......................
Õ¬à∑Ÿ ∫’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.....................
Ù. ¢“â 懮ⓢշ ¥ß√“§“∑√—æ¬å∑Ë’¢Õ∑”πμ‘ °‘ √√¡π‡È’ ªπì ‡ß‘π........................ı....,.............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à (Àâ“À¡Ë◊π∫“∑∂«â π)
(Ò) ¢â“懮“â ‰¡à‰¥â√∫— ‚Õπ·∑πÀ√◊Õ‡æÕ◊Ë ª√–‚¬™πå·°∫à §ÿ §≈μà“ߥ⓫
(Ú) √“§“∑√æ— ¬å∑·’Ë ¥ß‰«â„π Ù. ‡ªìπ√“§“∑·’Ë ∑®â √‘ß
(Û) .·..∫..ßà..°..√..√..¡... ..∑‘..∏...‘√Ï ..«..¡...μ...“..¡..§..”..¢..Õ...≈..ß..«..π— ..∑...’Ë ........‡.¥...Õ◊ ..π.....................æ...»..............................................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................
«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™Õ◊Ë ............π..“..¬....§.....,..π..“..¬....ß...................ºŸâ¢Õ ∂Õ◊ °√√¡ ‘∑∏Ï‘
≈ß™◊ËÕ............π..“..¬....°..................................ºŸâ¢Õ ∂Õ◊ °√√¡ ∑‘ ∏‘Ï
≈ß™ËÕ◊ ......................................................º ⟠Õ∫ «π
(......................................................)
”À√—∫æπ—°ß“π‡®â“Àπâ“∑’Ë
Ò) √“§“ª√–‡¡‘π∑ÿπ∑√æ— ¬å.....................................................................................................∫“∑........................................ μ“ߧå
Ú) ‚©π¥∑¥’Ë π‘ „À¡à√–«“ß........5..51..13..36.6..I.V.I.V...7.72..2..28..8›..›1..1..........‡≈¢∑’¥Ë π‘ .................ÚÒ..Ù............................Àπâ“ ”√«®.........Ù..Ú.Ù..ı...........................
‚©π¥∑Ë’¥‘π‡≈¢∑.Ë’ ...................ı..Û.Ò.˘.Ú..Ú.Û..Ò.....................‡≈¡à ........................ıÒ..ÙÛ............................Àπâ“..................Û.˘.Ò.Ú.............................
®”π«π∑¥’Ë π‘ ............................Ò.›.........................‰√.à .............................Û›...................ß“π..............................›.ı...................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò..Ú.........................‰√.à .............................››...................ß“π.............................›..›...................μ“√“ß«“
Û) ‰¥®â ¥∑–‡∫’¬π·≈«â ·μà«—π∑’.Ë ................................‡¥◊Õπ............................................æ.»......................
≈ß™Ë◊Õ.......................................................
(......................................................)
‡®â“æπ—°ß“π∑Ë’¥‘π
ÙÒˆ
μ—«Õ¬à“ßÀ¡“¬‡≈¢ Ûı μ“¡√–‡∫’¬∫¢Õâ Ò˘ (Û) «√√§ Õß (∑.¥. Ò)
∑∫Ë’ “â π
·∫ßà °√√¡ ‘∑∏√‘Ï «¡ °√≥·’ ª≈ß·¬°‡ªìπ¢Õߺ⟄À‡â ™à“ ∑ Ë’ «π/‰√à
∑Ë’π“
∑’Ë..............
§”¢Õ®¥∑–‡∫¬’ π ∑‘ ∏‘·≈–πμ‘ °‘ √√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑Ë’¥π‘ ª√–‡¿∑..·..∫...àß..°..√..√..¡.. ...∑‘ ..∏..Ï‘√..«..¡.............
μ”·Àπàß∑Ë’¥‘π (§√Õ∫°“√‡™à“) ·¬° Ú
√–«“ß........................5..1..3..6...I.V....7..2..2..8..›..1......................................... μ”∫≈.........................................................................................
‡≈¢∑Ë’¥π‘ .............................Ú..Û...................................................... Õ”‡¿Õ........................................................................................
Àπ“â ”√«®........................Ù..Ù...Ù.....................................................®—ßÀ«—¥........................................................................................
’∑Ë¥‘π·ª≈ß∑Ë’·¬°‰ªπ’ȉ à¡¡’°“√‡™à“§√Õ∫μ‘¥Õ¬Ÿàμ“¡ —≠≠“‡™à“ ’∑Ë¥‘π‡©æ“– à«π ©∫—∫≈ß«—π∑’Ë...........‡¥◊Õπ..................æ.». .... ·μàÕ¬à“ß„¥‚©π¥∑¥’Ë π‘
‡®â“æ —π°ß“π Ë’∑ ‘¥π ‡≈¢∑’Ë.....................ı..Û..˘...Ò................‡≈¡à ............ı..Ù..........................Àπâ“.....˘..Ò.............................
®”π«π∑¥’Ë ‘π.............Û..Ú....................‰√.à .............›...................ß“π...............›....................μ“√“ß«“
Ò. ¢â“懮⓺⡟ ’π“¡μàÕ‰ªπÈ’ ¡§’ «“¡ª√– ߧ¢å Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–πμ‘ ‘°√√¡‡°’ˬ«°∫— Õ ß— À“√‘¡∑√æ— ¬å∑Ë°’ ≈“à «¢â“ß∫ππ’È ·≈–
‰¥âªØ≠‘ “≥μπ·≈«â ¢Õ„Àâ∂âÕ¬§”¥«â ¬§«“¡ μ— ¬®å √‘ß ∂“â ¢“â 懮ⓄÀ∂â Õâ ¬§”‰¡‡à ªì𧫓¡®√ß‘ „Àâ„™∂â âÕ¬§”π¬È’ π— ¢â“懮“â „π∑“ߧ¥’Õ“≠“‰¥â
Ú. ¢â“懮“â .............Ò......π..“..¬....°........................ ‡≈¢ª√–®”μ—«ª√–™“™π ºâŸ...∂..◊Õ..°...√..√..¡.. ..‘∑...∏..‘Ï ...............
Ú. 𓬠§.
.............Û... .π...“..¬...ß... .....................
Õ“¬.ÿ ..........Û....,...Ù...ı.............ªï ≠— ™“μ‘.................‰..∑..¬....................∫¥‘ “/¡“√¥“™Õ◊Ë .............................................................................
‚ ¥ À¡“â ¬ § Ÿà ¡√ ™Õ◊Ë ..........................................................................................
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.....................
Û. ¢â“懮â“...............π..“..¬....§........................... ‡≈¢ª√–®”μ—«ª√–™“™π ºâ.Ÿ ..∂..◊Õ...°..√..√..¡.. ...‘∑..∏..Ï‘...............
................................................
Õ“¬.ÿ .........Ù..ı.ı.....................ªï ≠— ™“μ.‘ .......‰.∑...¬.....‰.∑...¬....................∫¥‘ “/¡“√¥“™Õ◊Ë .............................................................................
‚ ¥ À¡“â ¬ §à Ÿ ¡√ ™◊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“â ¢Õ· ¥ß√“§“∑√—æ¬∑å ¢’Ë Õ∑”πμ‘ °‘ √√¡π‡’È ªπì ‡ßπ‘ ........................ı....,.............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à (À“â À¡Ë◊π∫“∑∂«â π)
(Ò) ¢“â 懮Ⓣ¡à‰¥â√—∫‚Õπ·∑πÀ√◊Õ‡æ◊ËÕª√–‚¬™πå·°à∫§ÿ §≈μà“ߥ⓫
(Ú) √“§“∑√æ— ¬∑å Ë·’ ¥ß‰«â„π Ù. ‡ªìπ√“§“∑·’Ë ∑â®√ß‘
(Û) .·..∫..ßà..°...√..√..¡.. ..‘∑..∏...√‘Ï ..«..¡...μ...“..¡..§..”..¢..Õ...≈..ß..«..—π..∑...’Ë ........‡..¥..Õ◊ ..π.....................æ...»..............................................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................
«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
≈ß™◊ËÕ............π..“..¬....°....,...π..“..¬...ß....................ºŸâ¢Õ ∂◊Õ°√√¡ ‘∑∏Ï‘
≈ß™ÕË◊ ............π..“..¬....§..................................ºŸâ¢Õ ∂Õ◊ °√√¡ ‘∑∏‘Ï
≈ß™ËÕ◊ ......................................................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........5..51..13.3.6.6..I.V.I.V...7.72..2..28..8›..›1.1...........‡≈¢∑Ë¥’ π‘ .................ÚÒ..ı............................Àπ“â ”√«®.........Ù..Ú.Ù..ˆ...........................
‚©π¥∑Ë¥’ π‘ ‡≈¢∑Ë.’ ...................ı..Û.Ò.˘.Ú..Û.Û..Ò.....................‡≈à¡........................ıÒ..ÙÛ............................Àπ“â .................Û..˘.Ò.Û.............................
®”π«π∑¥’Ë π‘ ...........................Ò..Ò.........................‰√.à .............................›...................ß“π.............................›..›...................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò..Ò.........................‰√.à .............................››...................ß“π.............................›..›...................μ“√“ß«“
Û) ‰¥â®¥∑–‡∫¬’ π·≈«â ·μà«π— ∑’.Ë ................................‡¥◊Õπ............................................æ.»......................
≈ß™ÕË◊ .......................................................
(......................................................)
‡®â“æπ—°ß“π∑’Ë¥‘π
ÙÒ˜
μ«— Õ¬à“ßÀ¡“¬‡≈¢ Ûı μ“¡√–‡∫’¬∫¢âÕ Ò˘ (Û) «√√§ Õß (∑.¥. Ò)
∑∫’Ë “â π
·∫ßà °√√¡ ‘∑∏Ï‘√«¡ °√≥·’ ª≈ß·¬°‡ªìπ¢Õߺ⟄Àâ‡™à“ ∑ ’Ë «π/‰√à
∑Ë’π“
∑Ë’..............
§”¢Õ®¥∑–‡∫’¬π ∑‘ ∏‘·≈–πμ‘ ‘°√√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ‘∑∏‘„π∑¥Ë’ π‘ ª√–‡¿∑..·..∫...àß..°..√..√..¡.. ...‘∑..∏..√‘Ï..«..¡.............
μ”·Àπàß∑’Ë¥‘π (§√Õ∫°“√‡™à“) ·ª≈ߧ߇À≈◊Õ
√–«“ß........................5..1..3..6...I.V....7..2..2..8..›..1.........................................μ”∫≈.........................................................................................
‡≈¢∑Ë’¥π‘ .............................Ú..Û......................................................Õ”‡¿Õ........................................................................................
Àπ“â ”√«®........................Ù..Ù...Ù.....................................................®ß— À«—¥........................................................................................
’∑Ë¥‘π·ª≈ß∑Ë’·¬°‰ªπ’ȉ¡à¡’°“√‡™à“§√Õ∫μ‘¥Õ¬Ÿàμ“¡ —≠≠“‡™à“∑Ë’ ‘¥π‡©æ“– à«π ©∫—∫≈ß«—π∑’Ë...........‡¥◊Õπ..................æ.». .... ·μàÕ¬à“ß„¥‚©π¥∑Ë’¥π‘
‡®â“æπ—°ß“π Ë’∑ ‘¥π ‡≈¢∑.’Ë ....................ı..Û..˘...Ò................‡≈¡à ............ı..Ù..........................Àπ“â ....˘...Ò.............................
®”π«π∑Ë¥’ π‘ .............Û..Ò....................‰√à..............›...................ß“π...............›....................μ“√“ß«“
Ò. ¢“â 懮⓺⡟ π’ “¡μÕà ‰ªπ’È ¡’§«“¡ª√– ߧå¢Õ®¥∑–‡∫¬’ π ∑‘ ∏‘·≈–π‘μ°‘ √√¡‡°’¬Ë «°—∫Õ ß— À“√‘¡∑√—æ¬å∑’°Ë ≈“à «¢“â ß∫ππÈ’ ·≈–
‰¥ªâ Ø‘≠“≥μπ·≈«â ¢Õ„À∂â Õâ ¬§”¥«â ¬§«“¡ μ— ¬®å √ß‘ ∂“â ¢â“懮ⓄÀâ∂Õâ ¬§”‰¡à‡ªπì §«“¡®√‘ß„Àâ„™∂â Õâ ¬§”π’Ȭ—π¢“â 懮“â „π∑“ߧ¥’Õ“≠“‰¥â
Ú. ¢“â 懮â“.............Ò......π..“..¬....°........................ ‡≈¢ª√–®”μ—«ª√–™“™π ºâ.Ÿ ..∂..◊Õ..°...√..√..¡.. ..∑‘...∏..Ï‘ ...............
Ú. 𓬠§.
.............Û.....π...“.¬....ß... .....................
Õ“¬ÿ...........Û....,...Ù...ı.............ªï ≠— ™“μ‘.................‰..∑..¬....................∫‘¥“/¡“√¥“™◊ÕË .............................................................................
‚ ¥ À¡“â ¬ § àŸ ¡√ ™Ë◊Õ..........................................................................................
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..“..¬....ß........................... ‡≈¢ª√–®”μ—«ª√–™“™π º.Ÿâ ..∂...Õ◊ ..°..√..√..¡.. ...‘∑..∏..Ï‘...............
................................................
Õ“¬ÿ..........Ù..ı.ı.....................ªï —≠™“μ‘........‰.∑...¬.....‰.∑...¬....................∫¥‘ “/¡“√¥“™Ë◊Õ.............................................................................
‚ ¥ À¡“â ¬ §àŸ ¡√ ™◊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...................................®—ßÀ«—¥.................................À¡“¬‡≈¢‚∑√»æ— ∑.å ....................
Ù. ¢“â 懮ⓢշ ¥ß√“§“∑√æ— ¬∑å ’¢Ë Õ∑”π‘μ°‘ √√¡πȇ’ ªìπ‡ß‘π........................ı....,.............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à (Àâ“À¡Ëπ◊ ∫“∑∂«â π)
(Ò) ¢â“懮Ⓣ¡à‰¥â√∫— ‚Õπ·∑πÀ√Õ◊ ‡æÕ◊Ë ª√–‚¬™πå·°∫à ÿ§§≈μ“à ߥ⓫
(Ú) √“§“∑√æ— ¬∑å ·Ë’ ¥ß‰«â„π Ù. ‡ªìπ√“§“∑’Ë·∑®â √ß‘
(Û) .·..∫..àß..°..√..√..¡... ..∑‘..∏...‘Ï√..«..¡...μ...“..¡..§..”..¢..Õ...≈..ß..«..—π..∑...’Ë ........‡.¥...◊Õ..π.....................æ...»..............................................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................
«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
≈ß™ÕË◊ ............π..“..¬....°....,...π..“..¬...§....................ºâŸ¢Õ ∂◊Õ°√√¡ ∑‘ ∏Ï‘
≈ß™ÕË◊ ............π..“..¬....ß..................................ºâŸ¢Õ ∂Õ◊ °√√¡ ‘∑∏‘Ï
≈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........5..51..13..36.6..I.V.I.V...7.72..2..28..8›..›1..1..........‡≈¢∑’¥Ë ‘π.................ÚÒ..ı............................Àπ“â ”√«®.........Ù..Ú.Ù..ˆ...........................
‚©π¥∑Ë’¥π‘ ‡≈¢∑’.Ë ...................ı..Û.Ò.˘.Ú..Û.Û..Ò.....................‡≈¡à ........................ıÒ..ÙÛ............................Àπâ“..................Û.˘.Ò.Û.............................
®”π«π∑¥Ë’ π‘ ............................Ò.Ò.........................‰√.à .............................›...................ß“π..............................›.›...................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò..Ò.........................‰√.à .............................››...................ß“π.............................›..›...................μ“√“ß«“
Û) ‰¥®â ¥∑–‡∫’¬π·≈«â ·μà«π— ∑.’Ë ................................‡¥Õ◊ π............................................æ.»......................
≈ß™◊ËÕ.......................................................
(......................................................)
‡®â“æπ—°ß“π∑Ë’¥‘π
μ«— Õ¬à“ßÀ¡“¬‡≈¢ Ûı μ“¡√–‡∫’¬∫¢âÕ Ò˘ (Û) «√√§ Õß ÙÒ¯
·∫ßà °√√¡ ‘∑∏‘Ï√«¡ °√≥’·ª≈ß·¬°‡ªπì ¢ÕߺŸâ„Àâ‡™à“ “√∫≠— ®¥∑–‡∫’¬π (√“¬°“√®¥∑–‡∫’¬π·ª≈߇¥¡‘ ‚©π¥‡≈¢∑’Ë ıÛ˘Ò)
®¥∑–‡∫’¬π ª√–‡¿∑°“√ ºâŸ„À â ≠— ≠“ ºâŸ√—∫ —≠≠“ ‡πÈ◊Õ∑’Ë¥‘π ‡π◊ÈÕ∑Ë’¥‘π √–«“ß ‡®â“æπ—°ß“π∑’Ë¥‘π
«π— ‡¥◊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’................. ‡™“à ‡©æ“– à«π Ò. 𓬠°. 𓬠¢. Ú Û ı › › › › (≈ß™Ë◊Õ) 𓬠æ.
‡¥Õ◊ π............... (¡’°”Àπ¥ ∫‘ ª)ï Ú. 𓬠§. º‡âŸ ™à“ 𓬠°. „À⇙“à ∑Ë’¥π‘ ‡©æ“– à«π¢Õßμπ·°à
æ.». ................. Û. 𓬠ß. 𓬠¢. «à π¢Õß∫§ÿ §≈Õ◊Ëπ§ß‡¥¡‘
«π— ∑’Ë................. ·∫àß°√√¡ ‘∑∏√Ï‘ «¡ Ò. 𓬠°. 𓬠°. › Û ı Ú › › 5136 IV 7228-1 (≈ß™Ë◊Õ).........................
𓬠§. ∑Ë’¥‘π·ª≈ß∑’·Ë ¬°‰ªπ’È°“√‡™“à ¬ß— §ß¡Õ’ ¬Ÿà ÚÙ
‡¥◊Õπ............... (§√Õ∫°“√‡™à“) Ú. 𓬠§. μ“¡ —≠≠“‡™“à ∑Ë’¥π‘ ‡©æ“– «à π ıÛ˘Ú
©∫∫— ≈ß«—π∑Ë’.......‡¥Õ◊ π..................æ.». ....
æ.». ................. Û. 𓬠ß.
Ò › › Ò › › 5136 IV 7228-1 (≈ß™ËÕ◊ ).........................
∑Ë¥’ π‘ ·ª≈ß∑·’Ë ¬°‰ªπ’ȉ¡¡à ’°“√‡™“à §√Õ∫μ‘¥Õ¬àŸ Úı
μ“¡ —≠≠“‡™“à ∑¥Ë’ π‘ ‡©æ“– «à π ©∫—∫≈ß«—π∑’Ë... ıÛ˘Û
‡¥Õ◊ π..................æ.». .... ·μàÕ¬“à ß„¥
𓬠ß. Ò››››› › (≈ß™ËÕ◊ ).........................
∑¥Ë’ ‘π·ª≈ߧ߇À≈◊Õ‰¡¡à ’°“√‡™à“§√Õ∫μ‘¥Õ¬àŸ
μ“¡ —≠≠“‡™“à ∑¥’Ë π‘ ‡©æ“– à«π ©∫∫— ≈ß«—π∑’Ë...
‡¥Õ◊ π..................æ.». .... ·μÕà ¬à“ß„¥
À¡“¬‡Àμÿ “√∫≠— ®¥∑–‡∫’¬π·ª≈ß·¬°‚©π¥‡≈¢∑Ë’ ıÛ˘Û ‰¡¡à °’ “√‡™“à §√Õ∫μ‘¥Õ¬àŸ‰¡àμÕâ ߬°√“¬°“√®¥·®âß·μÕà ¬“à ß„¥
μ«— Õ¬“à ßÀ¡“¬‡≈¢ Ûı μ“¡√–‡∫¬’ ∫¢âÕ Ò˘ (Û) «√√§ Õß
·∫ßà °√√¡ ‘∑∏‘Ï√«¡ °√≥’·ª≈ß·¬°‡ªìπ¢ÕߺŸâ„Àâ‡™à“ “√∫—≠®¥∑–‡∫’¬π
(√“¬°“√®¥·®âß∑¥’Ë ‘π·ª≈ß∑Ë·’ ¬°‰ª„À¡à‚©π¥‡≈¢∑Ë’ ıÛ˘Ú)
®¥∑–‡∫’¬π ª√–‡¿∑°“√ ºŸâ„À â ≠— ≠“ ºâŸ√—∫ —≠≠“ ‡π◊ÈÕ∑Ë’¥‘π ‡πÈ◊Õ∑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 ‡©æ“– «à π 𓬠°. 𓬠¢. › Û ı › › › › (≈ß™Õ◊Ë ) 𓬠æ.
‡¥Õ◊ π............... (¡°’ ”Àπ¥ ∫‘ ª)ï º‡âŸ ™à“ «—π∑’Ë............................
æ.».................. (§√Õ∫°“√‡™à“) °“√‡™à“¬—ߧߡ’Õ¬àμŸ “¡ —≠≠“‡™“à ∑’Ë¥‘𠇥◊Õπ.........................
‡©æ“– «à π ©∫∫— ≈ß«—π∑’.Ë ......‡¥Õ◊ π................ æ.». ...........................
æ.». .... (≈ß™Õ◊Ë )......................
ÙÒ˘
ÙÚ
μ—«Õ¬à“ßÀ¡“¬‡≈¢ Ûˆ μ“¡√–‡∫’¬∫¢Õâ Ò˘ (ı) (∑.¥. Ò)
∑∫Ë’ “â π
∑’Ë «π/‰√à
∑’Ëπ“
∑Ë.’ .............
§”¢Õ®¥∑–‡∫’¬π ∑‘ ∏·‘ ≈–π‘μ°‘ √√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑¥Ë’ π‘ ª√–‡¿∑.....ª..≈..Õ...¥..°..“..√..‡..™..“à .................
μ”·Àπàß∑’Ë¥‘π
√–«“ß......................../.................................................................μ”∫≈.........................................................................................
‡≈¢∑Ë¥’ π‘ .....................................................................................Õ”‡¿Õ........................................................................................
Àπâ“ ”√«®..................................................................................®—ßÀ«¥— ........................................................................................
‚©π¥∑Ë’¥π‘
‡≈¢∑.Ë’ ....................Ò..Ú...Û..................‡≈à¡............Ò..Û..........................Àπâ“....Û................................
®”π«π∑’¥Ë π‘ .............Û..Ò....................‰√à..............›...................ß“π...............›....................μ“√“ß«“
∑’Ë ‘¥π·ª≈ßπ’Èæâπ®“°°“√‡™à“μ“¡ —≠≠“‡™à“ Ë’∑ ‘¥π ©∫—∫≈ß«—π∑Ë’...........‡¥◊Õπ..................æ.». .... Ò. ¢“â 懮“â ºŸâ¡π’ “¡μÕà ‰ªπ’È ¡’§«“¡ª√– ߧå¢Õ®¥∑–‡∫’¬π ∑‘ ∏·‘ ≈–πμ‘ ‘°√√¡‡°’ˬ«°—∫Õ —ßÀ“√‘¡∑√æ— ¬∑å ’°Ë ≈à“«¢“â ß∫ππÈ’ ·≈–
μ“¡∫—π∑÷°¢âÕμ°≈ߪ≈Õ¥°“√‡™à“ © —∫∫≈ß«—π∑’Ë...........‡ ◊¥Õπ..................æ.». ....
‰¥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“â „π∑“ߧ¥’Õ“≠“‰¥â
‡ ⮓æπ—°ß“π ’Ë∑ ‘¥π
Ú. ¢“â 懮“â ...............π..“..¬....¢........................... ‡≈¢ª√–®”μ—«ª√–™“™π ºâŸ...‡.™..à“................................
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Õ“¬ÿ...........Û....,...Ù...ı.............ªï —≠™“μ.‘ ................‰..∑..¬....................∫‘¥“/¡“√¥“™ËÕ◊ .............................................................................
‚ ¥ À¡“â ¬ §àŸ ¡√ ™Õ◊Ë ..........................................................................................
Õ¬∑àŸ ∫’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.....................
Û. ¢“â 懮“â ...............π..“..¬....°........................... ‡≈¢ª√–®”μ—«ª√–™“™π ºâŸ...„..À..‡â .™..“à............................
................................................
Õ“¬ÿ..........Û...ı.....................ªï —≠™“μ.‘ .......‰.∑...¬.....‰.∑...¬....................∫¥‘ “/¡“√¥“™◊ËÕ.............................................................................
‚ ¥ À¡“â ¬ § Ÿà ¡√ ™Ë◊Õ....................................................... —≠™“μ.‘ ......................
Õ¬Ÿ∑à ∫Ë’ “â π/À¡∫Ÿà “â π..........................‡≈¢∑.Ë’ ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡à∑Ÿ Ë’..............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«¥— .................................À¡“¬‡≈¢‚∑√»æ— ∑.å ....................
Ù. ¢â“懮ⓢշ ¥ß√“§“∑√æ— ¬å∑’¢Ë Õ∑”πμ‘ °‘ √√¡π’‡È ªìπ‡ßπ‘ ........................ı....,.............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à (À“â À¡Ëπ◊ ∫“∑∂â«π)
(Ò) ¢“â 懮“â ‰¡à‰¥√â —∫‚Õπ·∑πÀ√Õ◊ ‡æÕ◊Ë ª√–‚¬™πå·°∫à ÿ§§≈μà“ߥ⓫
(Ú) √“§“∑√—æ¬å∑·Ë’ ¥ß‰«â„π Ù. ‡ªπì √“§“∑·Ë’ ∑®â √‘ß
(Û) .∑..¥Ë’ ..π‘...·..ª..≈...ß..π..·’È ..¬..°...¡..“..®..“..°..‚.©...π..¥..∑...Ë’ ...................Õ..”..‡.¿...Õ...................‰.¥..æâ...âπ..®..“..°..°..“..√..‡..™..“à ..μ..“..¡.. ..≠—....≠...“..‡.™..à“..∑..Ë¥’...‘π...©...∫..∫—...≈..ß..«..—π..∑...’Ë ........
.‡.¥..Õ◊...π.................................æ....»..............μ...“..¡..∫..—π...∑..÷°..¢..Õâ...μ..°..≈...ß..ª..≈..Õ...¥..°..“..√..‡.™...“à ...©..∫...—∫..≈..ß..«..π—...∑..Ë’................‡.¥..◊Õ...π.................................æ.....»..................................
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«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
≈ß™ÕË◊ .....................π...“.¬....¢..........................ºŸâ¢Õ ‡™“à
≈ß™Ë◊Õ.....................π...“.¬....°..........................ºâŸ¢Õ „À‡â ™“à
≈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..........5..1.3..6›....I.V....7..2..2..8..›.1...........‡≈¢∑Ë¥’ ‘π.................›Ò..............................Àπ“â ”√«®.........›..Ú..............................
‚©π¥∑¥’Ë ‘π‡≈¢∑’Ë......................›.Ò..Ú...Û..Ò.....................‡≈à¡.......................›.Ò..Û............................Àπâ“.................Û..›.Ò..............................
®”π«π∑¥’Ë π‘ ...........................Ò..›.........................‰√.à .............................›...................ß“π.............................›..›...................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò..›.........................‰√.à .............................››...................ß“π.............................›..›...................μ“√“ß«“
Û) ‰¥®â ¥∑–‡∫¬’ π·≈â«·μ«à —π∑.Ë’ ................................‡¥Õ◊ π............................................æ.»......................
≈ß™ËÕ◊ .......................................................
(......................................................)
‡®â“æπ—°ß“π∑Ë’¥‘π
μ«— Õ¬à“ßÀ¡“¬‡≈¢ Ûˆ μ“¡√–‡∫¬’ ∫¢Õâ Ò˘ (ı) ÙÚÒ
(∑.¥. Òˆ)
∫π— ∑÷°¢âÕμ°≈ߪ≈Õ¥°“√‡™“à
∑Ë’¥‘π
√–«“ß.............5..15..31.6.3..6.I.V.I.V..7..27..2..82..›8..1›..1........................................μ”∫≈........................................................................
‡≈¢∑Ë’¥‘π................˘..Ú..Û...........Àπ“â ”√«®........Ú..Ù.¯.Ù................Õ”‡¿Õ.......................................................................
‚©π¥À¡“¬‡≈¢∑.Ë’ .........Ò...Û..ı..Û...˘..Ò.........................................®—ßÀ«¥— .......................................................................
∑«’Ë “à °“√.....................................................................
«—π∑Ë.’ ...............‡¥◊Õπ........................................æ.».....................
¢“â 懮“â .....................π..“..¬....¢.......º..Ÿâ‡..™..à“........................................................ ‡≈¢ª√–®”μ—«ª√–™“™π
.....................π..“..¬....°........º..Ÿâ.„.À..‡â..™..“à ....................................................
Õ“¬.ÿ ..ı.....,..Û.........ªï ‡™È◊Õ™“μ.‘ .............................. —≠™“μ‘........‰..∑..¬..,...‰.∑..¬...........∫¥‘ “/¡“√¥“™ÕË◊ ............................................................
Õ¬Ÿà∑’∫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..............................
¢//Õ//ª//Ø//≠‘ //“/≥///μ//π//·/≈//–//„/À//â∂//Õâ //¬/§//”//μ/àÕ//.....‰..¥..â∑...”.∫...—π..∑..°÷...¢..âÕ..μ...°..≈..ß..μ..Õà...‡.®..â“..æ..π...°— ..ß..“..π..∑...Ë¥’ ..π‘.....................................................................................
¥//«â//¬//§//«/“/¡// //μ—//¬//®å /√//ß‘ / ¥—ßμÕà ‰ªπ’È :›
......................∑...¥’Ë ..‘π...·..ª..≈...ß..‡.§...√..Õ◊Ë...ß..À..¡...“..¬..¢..â“..ß..∫...π..π...’È.·...¬..°...¡..“..®..“..°...‚.©..π...¥..‡..≈..¢..∑...Ë’................Õ...”..‡.¿...Õ..................................‚..¥..¬...¢..“â..æ...‡.®..â“....π..“..¬....°.....º..Ÿâ„..À..‡â..™..à“......
.‰.¥..â.„.À...â .π...“..¬...¢......‡.™...“à ..∑..’Ë¥...‘π..‰..«..â .μ...“..¡.. ...—≠...≠...“..‡..™..à“..∑..Ë¥’...‘π....©..∫...∫—..≈...ß..«..—π...∑...’Ë............‡.¥...◊Õ..π........................æ....»...............∫..¥—...π..’È..¢..“â..æ...‡.®..â“..∑...ß—È .. ..Õ...ß..Ω..É“..¬...μ..°...≈..ß..°...—π..„.À...∑â..Ë’¥...‘π..·...ª..≈...ß......
.‡.§..√..ËÕ◊...ß..À...¡..“..¬..¢...“â ..ß..∫..π...π..æÈ’...âπ..®...“..°..°..“..√..‡..™..à“..‰.ª.... ...«à..π..‚..©..π...¥..∑...’Ë¥..‘π...‡.≈...¢..∑..’Ë.................................................§..ß..¡...°’ ..“..√..‡..™..à“..Õ..¬...àŸμ..“..¡...‡.¥...¡‘ .........................................................
......................∫...—π..∑...÷°..¢..Õâ...μ..°...≈..ß..π...’∑È ..”..‰..«..âÀ..π...÷Ëß..©..∫...—∫....‡.°...Á∫..‰..«..â .≥..... ...”.π...°—..ß..“..π...∑..’¥Ë...π‘....∑..ß—È... ..Õ..ß...Ω..É“..¬..‰..¥..âμ...√..«..®..¥...∫Ÿ ..π—...∑..÷°...¢..âÕ..μ...°..≈...ß..·..≈...–..‡.¢...“â ..„.®..¢..Õâ...§..«...“.¡..........
μ...≈..Õ...¥..·...≈..«â....®..÷ß..≈...ß..≈..“..¬...¡..◊Õ...™..ËÕ◊ ..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..Ÿâ‡..™..à“............................................
............................................................................................≈..ß...™..Ë◊Õ...........................................................π......“....¬.........°......................................................º..Ÿâ.„.À...‡â .™..“à........................................
............................................................................................≈..ß...™..◊ËÕ....................................................................................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..◊ËÕ.....................................................................................................................................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...àß..‡.ª...ìπ.. ...”..§..≠—..........................................................
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μ—«Õ¬“à ßÀ¡“¬‡≈¢ Ûˆ μ“¡√–‡∫¬’ ∫¢Õâ Ò˘ (ı) ÙÚÚ
“√∫≠— ®¥∑–‡∫’¬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◊
𓬠¢. ‚©π¥∑’¥Ë ‘π„À¡à ª√–∑∫— μ√“
ºâ‡Ÿ ™à“ ‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
«“ «“
«—π∑Ë.’ ................ ‡™à“ (¡’°”Àπ¥ ∫‘ ª)ï 𓬠°. Ò››››› › (≈ß™ËÕ◊ ) 𓬠æ.
‡¥◊Õπ............... (§√Õ∫°“√‡™à“) «—π∑’Ë............................
æ.». ................. °“√‡™“à ¬ß— §ß¡’Õ¬àŸμ“¡ ≠— ≠“‡™à“∑Ë’¥‘𠇥◊Õπ.........................
©∫∫— ≈ß«π— ∑Ë.’ ........‡¥Õ◊ π................æ.». .... æ.». ...........................
(≈ß™ËÕ◊ )......................
«—π∑’.Ë ................ ª≈Õ¥°“√‡™“à 𓬠¢. 𓬠°. Ò››››› › (≈ß™ÕË◊ )......................
‡¥◊Õπ............... ºŸ‡â ™à“
æ.». ................. ∑¥Ë’ ‘π·ª≈ßπ’Èæâπ®“°°“√‡™“à μ“¡ ≠— ≠“‡™“à
∑Ë’¥π‘ ©∫—∫≈ß«π— ∑Ë.’ ......‡¥Õ◊ π...............æ.». ....
μ“¡∫π— ∑°÷ ¢Õâ μ°≈ߪ≈Õ¥°“√‡™à“
©∫∫— ≈ß«π— ∑’.Ë ......‡¥◊Õπ...............æ.». ....
μ«— Õ¬à“ßÀ¡“¬‡≈¢ Û˜ μ“¡√–‡∫’¬∫¢Õâ Ú¯ ÙÚÛ
(∑.¥. Ò)
∑∫’Ë “â π
∑’ Ë «π/‰√à
∑Ë’π“
∑.’Ë .............
§”¢Õ®¥∑–‡∫’¬π ∑‘ ∏‘·≈–π‘μ‘°√√¡ πÕ°‡¢μ
„π‡¢μ
·≈–°“√ Õ∫ «π ‘∑∏‘„π∑’¥Ë ‘π ª√–‡¿∑...‡..™..à“...(.¡...’°..”..À..π..¥... ..‘∫..ª...ï).........
μ”·Àπàß∑Ë’¥‘π (¡’‡ßËÕ◊ π‡«≈“)
√–«“ß........................5..1..3..6...I.V....7..2..2..8..›..1......................................... μ”∫≈.........................................................................................
‡≈¢∑Ë’¥π‘ .............................Ú..Û...................................................... Õ”‡¿Õ........................................................................................
Àπâ“ ”√«®........................Ù..Ù...Ù.....................................................®ß— À«—¥........................................................................................
‚©π¥∑’¥Ë π‘
‡≈¢∑’Ë.....................ı..Û..˘...Ò................‡≈¡à ............ı..Ù..........................Àπâ“....˘...Ò.............................
®”π«π∑¥’Ë ‘π.............Û..Ò....................‰√.à .............›...................ß“π...............›....................μ“√“ß«“
Ò. ¢“â 懮⓺¡âŸ ’π“¡μàÕ‰ªπÈ’ ¡’§«“¡ª√– ߧå¢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“â „Àâ∂âÕ¬§”‰¡‡à ªπì §«“¡®√‘ß„Àâ„™â∂Õâ ¬§”π¬’È —π¢â“懮Ⓞπ∑“ߧ¥’Õ“≠“‰¥â
°“√‡™à“√“¬πÈ’ য় — ≠≠“μ°≈ß°—π„Àâ¡’º≈π—∫·μà«—π∑Ë’...........‡ ◊¥Õπ..................æ.». .... ‡ ìªπμâπ‰ª Ú. ¢“â 懮â“.............π...“.¬....°............................. ‡≈¢ª√–®”μ—«ª√–™“™π ºâ.Ÿ ..„.À...‡â .™..“à............................
‡ ⮓æπ—°ß“π ’Ë∑¥‘π
.................................................
Õ“¬ÿ...........Û.......................ªï —≠™“μ‘.................‰..∑..¬....................∫¥‘ “/¡“√¥“™Õ◊Ë .............................................................................
‚ ¥ À¡“â ¬ § àŸ ¡√ ™◊ÕË ..........................................................................................
Õ¬Ÿà∑’∫Ë â“π/À¡Ÿà∫“â π..........................‡≈¢∑.’Ë ...............μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡Ÿ∑à Ë’..............
μ”∫≈/·¢«ß...................................Õ”‡¿Õ/‡¢μ...................................®—ßÀ«—¥.................................À¡“¬‡≈¢‚∑√»—æ∑å.....................
Û. ¢“â 懮“â ...............π..“..¬....¢........................... ‡≈¢ª√–®”μ—«ª√–™“™π º.Ÿâ ..‡.™...à“...............................
................................................
Õ“¬.ÿ .........ı...ı.....................ªï —≠™“μ.‘ .......‰.∑...¬.....‰.∑...¬....................∫¥‘ “/¡“√¥“™ÕË◊ .............................................................................
‚ ¥ À¡“â ¬ §àŸ ¡√ ™Ë◊Õ....................................................... ≠— ™“μ‘.......................
Õ¬à∑Ÿ ’∫Ë â“π/À¡àŸ∫â“π..........................‡≈¢∑’Ë................μ√Õ°/´Õ¬.......................................∂ππ.....................................À¡Ÿ∑à 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‘ ...................Ò.....ı..,..,.............................∫“∑.........›........... μ“ߧå
ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à (Àπ(ÀËß÷ â“·À ¡πË◊π∫∫“∑“∑∂∂«â π«â π) )
(Ò) ¢â“懮“â ‰¡à‰¥√â —∫‚Õπ·∑πÀ√◊Õ‡æ◊ÕË ª√–‚¬™π·å °à∫§ÿ §≈μ“à ߥ⓫
(Ú) √“§“∑√—æ¬∑å ’Ë· ¥ß‰«â„π Ù. ‡ªìπ√“§“∑Ë·’ ∑â®√‘ß
(Û) .‡.™..à“..∑..¥’Ë...π‘ ..‰.«..‡â.æ...ËÕ◊................................°..“..√..‡.™..“à..¡...°’ ..”..À..π..¥... ..∫‘..ª...πï ..—∫..·...μ..à«..π—..∑...Ë’ ........‡..¥..◊Õ..π....................æ...»..........™..”..√..–..§...à“.‡..™..à“..‡.ª..πì...√..“..¬..ª..ï.
.ª..ï≈..–....Ò....,..........∫..“..∑....(.À..π...÷ßË ..À..¡..πË◊...∫..“..∑..∂...â«..π..)...™..”..√..–..§..“à..‡.™..à“..¿...“.¬...„.π..«..π—...∑..’Ë....................................................../.. ..ß‘Ë..ª...≈..Ÿ°.. ..√..“â..ß..‰..¡..à¡..’...................
(Ù) .„.π..°..“..√..‡..™..“à ..∑..Ë¥’ ..‘π...√..“.¬...π..È’º..Ÿâ.„.À..‡â..™..“à ..À..“â ..¡..¡..„‘..À..ºâ..⟇..™..à“..„.À..ºâ...ÕŸâ ..Ë◊π..‡..™..à“..™..à«..ß..................................................................................
«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
≈ß™◊ÕË .....................π...“..¬...°.........................ºâŸ¢Õ „À‡â ™“à
≈ß™Ë◊Õ.....................π...“..¬...¢.........................ºâŸ¢Õ ‡™“à
≈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........5..51..13.3.6.6..I.V.I.V...7.72..2..28..8›..›1.1...........‡≈¢∑Ë¥’ π‘ .................ÚÒ..ı............................Àπâ“ ”√«®.........Ù..Ú.Ù..ˆ...........................
‚©π¥∑¥’Ë π‘ ‡≈¢∑Ë.’ ...................ı..Û.Ò.˘.Ú..Û.Û..Ò.....................‡≈à¡........................ıÒ..ÙÛ............................Àπ“â .................Û..˘.Ò.Û.............................
®”π«π∑¥Ë’ π‘ ...........................Ò..Ò.........................‰√.à .............................›...................ß“π.............................›..›...................μ“√“ß«“
§ß‡À≈Õ◊ ................................Ò..Ò.........................‰√.à .............................››...................ß“π.............................›..›...................μ“√“ß«“
Û) ‰¥â®¥∑–‡∫’¬π·≈â«·μà«—π∑’.Ë ................................‡¥Õ◊ π............................................æ.»......................
≈ß™ËÕ◊ .......................................................
(......................................................)
‡®â“æπ—°ß“π∑Ë’¥‘π
ÙÚÙ
μ«— Õ¬“à ßÀ¡“¬‡≈¢ Û˜ μ“¡√–‡∫¬’ ∫¢âÕ Ú¯
(∑.¥. Ûˆ)
Àπß— Õ◊ ≠— ≠“‡™à“∑¥Ë’ ‘π (¡°’ ”Àπ¥ ‘∫ªï) (¡’‡ßËÕ◊ π‡«≈“)
∑Ë’¥‘π
‚©π¥∑.Ë’ .........................................‡≈¢∑¥Ë’ ‘π.........................................Àπ“â ”√«®...............................................
μ”∫≈............................................Õ”‡¿Õ............................................®—ßÀ«¥— ....................................................
Àπß— ◊Õ —≠≠“πÈ’‰¥∑â ”‡¡◊ËÕ«—π∑Ë’..................‡¥◊Õπ..............................................æ∑ÿ ∏»°— √“™.............................................
≥ ”π—°ß“π∑Ë¥’ π‘ ®ß— À«¥— .................................................... } { }................
ºŸâ„À‡â ™à“™à«ß Õ“¬ÿ ......Û.......... ªï
‡≈¢ª√–®”μ—«ª√–™“™π ................
{ }...............................................
√–À«à“ß ...............π..“..¬....°.........................
...............................................
≠— ™“μ‘............‰.∑..¬.....................∫‘¥“/¡“√¥“™ËÕ◊ ...............................................................................................................................
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 .........................
‡≈¢ª√–®”μ—«ª√–™“™π
{ }............................................... } { }................
ºŸ‡â ™“à ™«à ß Õ“¬ÿ ......ı.......... ªï
°∫— .................π..“..¬....¢....................... ................
...............................................
—≠™“μ.‘ .............‰.∑...¬..................∫‘¥“/¡“√¥“™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 .........................
∑ßÈ— ÕßΩÉ“¬‰¥μâ °≈ß∑” —≠≠“°—π¥ß— μÕà ‰ªπ’È
¢Õâ Ò. ºŸâ„À‡â ™à“„Àºâ ‡Ÿâ ™“à ‡™“à ∑’Ë¥π‘ ·ª≈ß∑’°Ë ≈“à «¢“â ß∫ππ∑È’ È—ß·ª≈ß ‰«â∑”...(.√..–..∫...ÿ«..à“..‡.™..“à..∑..”..Õ..–..‰..√..)...........................................
....................................................................................................................................................................................................
¡°’ ”Àπ¥............. ...∫‘ ..ª..ï.................ª.ï ...............›...................‡¥◊Õπ π—∫μÈ—ß·μ«à π— .∑..Ë’...........‡.¥..◊Õ...π..............................æ...».........................‡ªìπμπâ ‰ª
¢âÕ Ú. º‡âŸ ™“à ¬Õ¡‡ ’¬§à“‡™à“·°ºà ⟄À⇙“à ‡ªπì ®”π«π‡ßπ‘ ................Ò.......,........›.............................................................∫“∑
(.À...π..ß÷Ë..·.. ...π..∫..“..∑...∂..«â ..π..)...‚.¥...¬..™..”..√..–..§..à“..‡.™...à“.‡..ª..ìπ..√..“..¬...ª..ïÊ...≈...–...Ò.....,..........›...∫..“..∑....™..”..√..–..¿..“..¬..„..π..«..—π..∑....’Ë ..................................................................................................................
¢Õâ Û. ßË‘ ª≈Ÿ° √“â ß„π∑Ë¥’ π‘ ·ª≈ßπ’È....‰.¡..à¡...’ ...................................................................................................................
„..π..°..“..√..‡.™..à“..∑...¥’Ë ..‘π..√..“..¬..π...È’À..â“..¡..¡...„‘ .À..ºâ...‡âŸ .™..“à..„.À...âº..ŸÕâ ..πË◊...‡.™..à“..™..à«..ß.............................................................................................................................
....................................................................................................................................................................................................
Àπ—ß ◊Õ —≠≠“πÈ’‰¥â∑”‡ªìπ “¡©∫—∫¡’¢âÕ§«“¡μ√ß°—π ”À√—∫ ”π—°ß“π∑Ë’¥‘πÀπË÷ß©∫—∫ ºŸâ„Àâ‡™à“·≈–ºâŸ‡™à“∂◊Õ‰«âΩÉ“¬≈–
ÀπË÷ß©∫∫— (©∫—∫π’È ”À√—∫..............................................................)
∑—Èß ÕßΩÉ“¬‰¥âμ√«®¥ŸÀπ—ß ◊Õ —≠≠“‡™à“√“¬πÈ’·≈–‡¢â“„®¢âÕ§«“¡μ≈Õ¥·≈â« ®÷߉¥â≈ß≈“¬¡◊Õ™◊ËÕ À√◊Õæ‘¡æå≈“¬πÈ‘«¡◊Õ‰«â
‡ªì𠔧—≠μÕà Àπâ“欓π·≈–‡®â“æπ—°ß“π∑Ë¥’ π‘
(≈ß≈“¬¡Õ◊ ™Ë◊պ⟄À⇙“à ).......................π..“..¬....°...........................................
(≈ß≈“¬¡◊Õ™ËÕ◊ ºâ‡Ÿ ™“à )...........................π..“..¬....¢............................................
(≈ß≈“¬¡◊Õ™ÕË◊ 欓π)............................................................................
(≈ß≈“¬¡◊Õ™Õ◊Ë æ¬“π)............................................................................
Àπ—ß Õ◊ ≠— ≠“πÈ’‰¥∑â ”μàÕÀπ“â
.................................................................................‡®“â æπ°— ß“π∑’Ë¥π‘
ª√–∑∫— μ√“μ”·Àπà߇ªπì ”§≠—
........................................................º‡âŸ ¢¬’ π
........................................................ºŸâμ√«®
μ«— Õ¬à“ßÀ¡“¬‡≈¢ Û˜ μ“¡√–‡∫’¬∫¢Õâ Ú¯
“√∫—≠®¥∑–‡∫’¬π
®¥∑–‡∫¬’ π ª√–‡¿∑°“√ ºŸâ„À â ≠— ≠“ ºŸâ√—∫ —≠≠“ ‡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◊
𓬠¢. ‚©π¥∑’¥Ë π‘ „À¡à ª√–∑∫— μ√“
ºŸ‡â ™à“ ‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
«“ «“
«—π∑Ë’................. ‡™à“ (¡°’ ”Àπ¥ ‘∫ªï) 𓬠°. Ò › › › › › › (≈ß™ÕË◊ )......................
‡¥Õ◊ π............... (¡’‡ß◊ËÕπ‡«≈“)
æ.». ................. °“√‡™“à √“¬πȧ’ àŸ ≠— ≠“μ°≈ß°π— „À¡â º’ ≈π∫— ·μà
«π— ∑’Ë.........‡¥Õ◊ π................æ.». .... ‡ªìπμâπ‰ª
ÙÚı
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รวมระเบียบ คำสั่ง เกี่ยวกับการจดทะเบียนสิทธิและนิติกรรมประเภท ก่อภาระผูกพัน และอื่น ๆ (ปี 2552)
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