รวมระเบียบ คำสั่ง เกี่ยวกับการจดทะเบียนสิทธิและนิติกรรมประเภท ก่อภาระผูกพัน และอื่น ๆ (ปี 2552)

Ù˜

μ°≈ß°—π„ÀâÕ —ßÀ“√‘¡∑√—æ¬å„¥Õ —ßÀ“√‘¡∑√—æ¬åÀπË÷ßæâπ®“° ‘∑∏‘‡°Á∫°‘π „À⇢’¬π
™ËÕ◊ ª√–‡¿∑«à“ çª≈Õ¥ ∑‘ ∏‡‘ °∫Á °‘πé À“°‡ªìπ°√≥∑’ ’Ë„π¢≥–®¥∑–‡∫¬’ π·∫àß·¬°
§Ÿà°√≥’μ°≈ß„Àâ∑’Ë¥‘π·ª≈ß∑Ë’·¬°ÕÕ°‰ªÀ√◊Õ∑’Ë¥‘π·ª≈ߧ߇À≈◊Õ‰¡à¡’ ‘∑∏‘‡°Á∫°‘π
μ‘¥‰ª¥â«¬ „À⇢’¬π™Ë◊Õª√–‡¿∑«à“ ç·∫àß·¬°„ππ“¡‡¥‘¡ (ª≈Õ¥ ‘∑∏‘‡°Á∫°‘π)é
À“°‡ªπì °“√®¥∑–‡∫¬’ π·∫ßà ‡ªπì ª√–‡¿∑ÕπË◊ „À‡â ªπì ‰ªμ“¡ª√–‡¿∑°“√®¥∑–‡∫¬’ π

(Ù) °√≥’‡®â“¢Õß∑’Ë¥‘πª√– ß§å®–·∫àß·¬°∑Ë’¥‘π∑’ˉ¥â®¥∑–‡∫’¬π ‘∑∏‘ ç·∫ßà ·¬°„ππ“¡‡¥¡‘
‡°Á∫°‘π‰«â·≈â«ÕÕ°®“°°—π ‚¥¬„π¢≥–®¥∑–‡∫’¬π·∫àß·¬°§Ÿà°√≥’μ°≈ß°—π„Àâ (§√Õ∫ ‘∑∏‡‘ °∫Á °π‘ )é
∑¥’Ë π‘ ·ª≈ߧ߇À≈Õ◊ À√Õ◊ ·ª≈ß∑·Ë’ ¬°ÕÕ°‰ª¬ß— §ß¡ ’ ∑‘ ∏‡‘ °∫Á °π‘ 쥑 ‰ª¥«â ¬ „À‡â ¢¬’ π
™Ë◊Õª√–‡¿∑«à“ ç·∫àß·¬°„ππ“¡‡¥‘¡ (§√Õ∫ ‘∑∏‘‡°Á∫°‘π)é À“°‡ªìπ°“√®¥
∑–‡∫’¬π·∫ßà ‡ªπì ª√–‡¿∑ÕπË◊ „À⇪πì ‰ªμ“¡ª√–‡¿∑°“√®¥∑–‡∫’¬π

(ı) °√≥’Õ —ßÀ“√‘¡∑√—æ¬å‰¥â¡’°“√®¥∑–‡∫’¬π ‘∑∏‘‡°Á∫°‘π‰«â μàÕ¡“ ç‡≈‘° ‘∑∏‘‡°Á∫°‘πé
§°Ÿà √≥ª’ √– ß§®å –‡≈°‘  ∑‘ ∏‡‘ °∫Á °π‘ μÕà °π— À√Õ◊ °√≥º’ ∑⟠√ß ∑‘ ∏‡‘ °∫Á °π‘ ∂ß÷ ·°§à «“¡μ“¬
·≈–‡®“â ¢ÕßÕ ß— À“√¡‘ ∑√æ— ¬¡å “¢Õ®¥∑–‡∫¬’ π‡≈°‘  ∑‘ ∏‡‘ °∫Á °π‘ μ“¡º≈¢Õß°ÆÀ¡“¬
„À‡â ¢’¬π™Õ◊Ë ª√–‡¿∑«à“ ç‡≈‘° ∑‘ ∏‘‡°∫Á °‘πé

¢Õâ ¯ °“√‡¢¬’ π§”¢Õ®¥∑–‡∫¬’ π ∑‘ ∏·‘ ≈–πμ‘ °‘ √√¡ (∑.¥.Ò , ∑.¥.Ò °) °“√‡¢¬’ π§”¢Õ
„Àªâ Ø‘∫μ— ‘ ¥ß— πÈ’

(Ò) „π™àÕߪ√–‡¿∑„À⇢’¬π™◊ËÕª√–‡¿∑°“√®¥∑–‡∫’¬π μ“¡¢âÕ ˜ °“√‡¢¬’ πª√–‡¿∑
·≈â«·μà°√≥’

(Ú) °“√‡¢’¬π™Ë◊ÕºâŸ∂◊Õ°√√¡ ‘∑∏‘Ï„π¢âÕ Ú ¢Õߧ”¢Õ®¥∑–‡∫’¬π ‘∑∏‘ °“√‡¢’¬π™ÕË◊ ‡®“â ¢Õß
·≈–πμ‘ °‘ √√¡μ“¡·∫∫ ∑.¥.Ò À√◊Õ ∑.¥.Ò ° „À‡â ¢¬’ π‡©æ“–™◊ËÕº∂⟠Õ◊ °√√¡ ∑‘ ∏∑Ï‘ ’Ë º¢Ÿâ Õ
¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡‡∑à“π—Èπ ‚¥¬‰¡àμâÕ߇¢’¬π™Ë◊ÕºâŸ∂◊Õ°√√¡ ‘∑∏Ï‘À√◊Õ
º∂Ÿâ Õ◊  ∑‘ ∏§‘ √Õ∫§√ÕßÕπ◊Ë ∑Ë’‰¡‡à °¬’Ë «¢Õâ ß·μÕà ¬“à ß„¥ °√≥¡’ º’ ∂Ÿâ Õ◊ °√√¡ ∑‘ ∏ÀÏ‘ ≈“¬§π
¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡„À⇢’¬π™◊ËÕ·≈–À¡“¬‡≈¢≈”¥—∫°”°—∫‰«âÀπâ“™◊ËÕ
ºâŸ∂Õ◊ °√√¡ ‘∑∏¥Ï‘ «â ¬

(Û) °“√‡¢¬’ π™ËÕ◊ ºŸ∑â √ß ∑‘ ∏‡‘ °∫Á °‘π„π¢âÕ Û ¢Õߧ”¢Õ®¥∑–‡∫¬’ π ∑‘ ∏‘ °“√‡¢’¬π™ÕË◊ º∑Ÿâ √ß ∑‘ ∏‘
·≈–π‘μ‘°√√¡μ“¡·∫∫ ∑.¥.Ò À√◊Õ ∑.¥.Ò ° „À⇢’¬π™◊ËÕºâŸ∑√ß ‘∑∏‘‡°Á∫°‘π
À“°¡À’ ≈“¬§π„À⇢’¬πÀ¡“¬‡≈¢°”°∫— ‰«â¢â“ßÀπâ“∑°ÿ ™ÕË◊ ¥â«¬

(Ù) °√≥’®¥∑–‡∫’¬π ‘∑∏‘‡°Á∫°‘π‡©æ“– à«π„ÀâÀ¡“¬‡Àμÿ‰«â ≥ √‘¡ ·∑ߢ“â ß°√≥‡’ °∫Á °π‘
¥â“π´â“¬¢Õߧ”¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡ (∑.¥.Ò , ∑.¥.Ò °) ·≈–„π ‡©æ“– à«π
 “√∫—≠®¥∑–‡∫’¬π„Àâμ√ß°—π«à“ ºŸâ∂◊Õ°√√¡ ‘∑∏Ï‘§π„¥‡ªìπºŸâ„Àâ ‘∑∏‘‡°Á∫°‘𠄧√
‡ªìπºŸâ∑√ß ‘∑∏‘‡°Á∫°‘π‡©æ“– à«π¢Õßμπ·≈– à«π¢Õ߇®â“¢ÕßÕË◊π¬—ߧ߇¥‘¡ ‡™àπ
∑Ë’¥‘π¡’™Õ◊Ë π“¬ °. π“ß ¢. ‡ªìπ‡®â“¢Õß π“¬ °. „Àπâ “¬ §. ‡ªπì º∑⟠√ß ‘∑∏‡‘ °∫Á °‘π

Ù¯

‡©æ“– à«π¢Õßμπ „ÀâÀ¡“¬‡Àμÿ«à“ ç𓬠°. „Àπâ “¬ §.‡ªπì º∑⟠√ß ∑‘ ∏‘‡°∫Á °‘π

‡©æ“– à«π¢Õßμπ‡∑à“π—Èπ  à«π¢Õß π“ß ¢. §ß‡¥‘¡é

π” “√– ”§≠— „ à (ı)  “√– ”§—≠∑’ˉ¥â®“°°“√ Õ∫ «π „Àâæπ—°ß“π‡®â“Àπâ“∑’Ë®¥≈߉«â

∑.¥.Ò „π§”¢Õ®¥∑–‡∫’¬π ‘∑∏·‘ ≈–πμ‘ ‘°√√¡ (∑.¥.Ò , ∑.¥.Ò °) ¥â«¬ (μ“¡μ—«Õ¬à“ß
› ¡’μ—«Õ¬à“ß∑’Ë Ò›Û À¡“¬‡≈¢ Ò - Û)

„™â ∑.¥.Òˆ ‡ªÀì ≈°— ∞“π ¢âÕ ˘ °“√®¥∑–‡∫’¬πª√–‡¿∑ ‘∑∏‘‡°Á∫°‘π „Àâ∑”‡ªìπ∫—π∑÷°

› ¡’μ—«Õ¬“à ß∑Ë’ Ò›Û ¢âÕμ°≈ßÀπ÷Ëß©∫—∫ ‡°Á∫‰«â ≥  ”π—°ß“π∑’Ë¥‘π „À⧟à°√≥’≈ß≈“¬¡◊Õ™Ë◊Õ„π∫—π∑÷°

¢âÕμ°≈ßμ“¡·∫∫ ∑.¥.Òˆ (μ“¡μ—«Õ¬à“ßÀ¡“¬‡≈¢ Ò - Û)

 ∑‘ ∏‘‡°Á∫°‘π‚¥¬∑“ß ¢âÕ Ò °√≥’∑Ë’ºŸâ∑√ß ‘∑∏‘‡°Á∫°‘π‰¥â ‘∑∏‘‡°Á∫°‘π¡“‚¥¬∑“ßæ‘π—¬°√√¡

æπ‘ ¬— °√√¡ æπ—°ß“π‡®â“Àπâ“∑Ë’μâÕß„ÀâºâŸ∑√ß ‘∑∏‘¬Ë◊π§”¢Õ‚Õπ¡√¥°°“√‰¥â¡“´÷Ëß ‘∑∏‘‡°Á∫°‘π
› ¡’μ«— Õ¬“à ß∑Ë’ Ù (∑.¥.¯) ·≈–¥”‡π‘π°“√Õ¬à“߇√◊ËÕß‚Õπ¡√¥° ‡¡◊ËÕ§√∫ª√–°“»‰¡à¡’¢âÕ¢—¥¢âÕß

®÷ß„À⮥∑–‡∫’¬π„πª√–‡¿∑ ‘∑∏‘‡°Á∫°‘π „π°“√¢Õ√—∫¡√¥°°“√‰¥â¡“´÷Ëß

 ‘∑∏‘‡°Á∫°‘π „Àâæπ—°ß“π‡®â“Àπâ“∑’Ë¥”‡π‘π°“√‡ªìπ‡√◊ËÕßÀπ÷Ëßμà“ßÀ“°®“°‡√Ë◊Õß

¢Õ√—∫¡√¥°„π∑Ë’¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬åÕË◊π´÷ËߺŸâ√—∫¡√¥°·μà≈–‡√Ë◊ÕßÕ“®¡“¢Õ„Àâ

¥”‡ππ‘ °“√„π«“√–‡¥¬’ «°π— À√Õ◊ μ“à ß«“√–°π— °Á‰¥â (μ“¡μ«— Õ¬à“ßÀ¡“¬‡≈¢ Ù)

°“√·∫ßà ·¬°√–À«à“ß ¢Õâ ÒÒ „π°√≥’∑Ë’¥‘π‰¥â®¥∑–‡∫’¬π ‘∑∏‘‡°Á∫°‘π‰«â·≈â« μàÕ¡“‰¥â¡’°“√

 ‘∑∏‡‘ °∫Á °‘π ¢Õ®¥∑–‡∫’¬π·∫àß·¬° „À∑â ¥’Ë ‘π·ª≈ß∑·Ë’ ¬°ÕÕ°‰ª¡ ’ ∑‘ ∏‘‡°∫Á °‘πμ‘¥‰ª¥«â ¬À√Õ◊

§Ÿ°à √≥μ’ °≈߉¡à„À â ‘∑∏‘‡°Á∫°‘πμ‘¥‰ª¥«â ¬ „Àæâ π°— ß“π‡®“â Àπâ“∑’∂Ë ◊ժؑ∫—μ‘ ¥ß— πÈ’

°√≥’§√Õ∫ ∑‘ ∏‡‘ °∫Á °‘π (Ò) °“√®¥∑–‡∫’¬π·∫àß·¬°∑’Ë¥‘π∑Ë’‰¥â®¥∑–‡∫’¬π ‘∑∏‘‡°Á∫°‘π‰«â·≈â«

∑È—ß·ª≈ß·¬°·≈– „À∑â ¥’Ë π‘ ·ª≈ß∑·’Ë ¬°ÕÕ°‰ª¡ ’ ∑‘ ∏‡‘ °∫Á °π‘ 쥑 ‰ª¥«â ¬ ‚¥¬°Õà π®¥∑–‡∫¬’ π·∫ßà ·¬°

·ª≈ß§ß „Àâ∫—π∑÷°∂âÕ¬§”¬‘π¬Õ¡¢ÕߺŸâ∑√ß ‘∑∏‘‰«â ·≈–„Àâ∫√√¬“¬¢â“ߧ”¢Õ®¥∑–‡∫’¬π

› ¡μ’ —«Õ¬“à ß∑Ë’ ı

 ‘∑∏‘·≈–π‘μ‘°√√¡ (∑.¥.Ò,∑.¥.Ò °) √«¡∑È—ß„π√“¬°“√®¥∑–‡∫’¬π „Àâª√“°Ø

°“√§√Õ∫ ‘∑∏‘‡°Á∫°‘π‰«â«à“ ç∑Ë’¥‘π·ª≈ß∑’Ë·¬°‰ªπÈ’·≈–∑Ë’¥‘π·ª≈ߧ߇À≈◊Õ

 ∑‘ ∏‡‘ °∫Á °π‘ ¬ß— §ß¡Õ’ ¬μŸà “¡∫π— ∑°÷ ¢Õâ μ°≈ß ∑‘ ∏‡‘ °∫Á °π‘ ©∫∫— ≈ß«π— ∑.’Ë ....‡¥Õ◊ π..........

æ.». ....é

«‘∏’°“√®¥·®âß°“√§√Õ∫ ‘∑∏‘‡°Á∫°‘π „À⬰√“¬°“√®¥∑–‡∫’¬π

 ∑‘ ∏‡‘ °∫Á °π‘ ´ßË÷ ¡Õ’ ¬àŸ„πÀπß—  Õ◊ · ¥ß ∑‘ ∏‘„π∑¥’Ë π‘ ‡¥¡‘ ‰ª®¥·®ßâ ≈߉«â„π “√∫≠— ®¥

∑–‡∫¬’ πÀπß—  Õ◊ · ¥ß ∑‘ ∏‘„π∑¥Ë’ π‘ ·ª≈ß·∫ßà ·¬° ‡©æ“–™Õà ߇πÕÈ◊ ∑¥’Ë π‘ μ“¡ ≠— ≠“

„Àâ≈ß®”π«π∑’Ë¥‘πμ“¡Àπ—ß ◊Õ· ¥ß ‘∑∏‘„π∑’Ë¥‘π„À¡à «—π∑Ë’®¥∑–‡∫’¬π·≈–

‡®â“æπ—°ß“π∑Ë’¥‘π≈ßπ“¡ „Àâ„™â™◊ËÕ·≈–«—π‡¥◊Õπªï‡¥‘¡·≈â«À¡“¬‡Àμÿ«à“

ç ‘∑∏‘‡°Á∫°‘π¬—ߧߡ’Õ¬àŸμ“¡∫—π∑÷°¢âÕμ°≈ß ‘∑∏‘‡°Á∫°‘π©∫—∫≈ß«—π∑’Ë.............

‡¥◊Õπ..........æ.».....é ‡®â“æπ—°ß“π∑’Ë¥‘π≈ß™Ë◊Õæ√âÕ¡¥â«¬«—π‡¥◊Õπªï °”°—∫‰«â

(μ“¡μ«— Õ¬à“ßÀ¡“¬‡≈¢ ı)

Ù˘

(Ú) °√≥’∑’ˉ¥â¡’°“√¢Õ®¥∑–‡∫’¬π·∫àß·¬°∑’Ë¥‘π‚¥¬§àŸ°√≥’μ°≈ß °√≥’·ª≈ß·¬°æâπ
¬π‘ ¬Õ¡„À∑â ¥’Ë π‘ μ“¡Àπß—  Õ◊ · ¥ß ∑‘ ∏‘„π∑¥Ë’ π‘ ·ª≈ß·∫ßà ·¬°ππÈ— æπâ ®“° ∑‘ ∏‡‘ °∫Á °π‘  «à π·ª≈ߧß

 ∑‘ ∏‘‡°Á∫°π‘ ¬ß— Õ¬àŸ

„Àâæπ—°ß“π‡®â“Àπâ“∑’Ë∑”∫—π∑÷°¢âÕμ°≈ߪ≈Õ¥ ‘∑∏‘‡°Á∫°‘π√–À«à“ߺŸâ∑√ß ‘∑∏‘·≈– › ¡μ’ «— Õ¬“à ß∑’Ë ˆ
‡®â“¢Õß∑Ë’¥‘π ·≈â«„Àâ∫√√¬“¬¢â“ߧ”¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡ (∑.¥.Ò,
∑.¥.Ò °) √«¡∑ßÈ— „π√“¬°“√®¥∑–‡∫’¬π„Àªâ √“°Ø°“√ª≈Õ¥ ‘∑∏‡‘ °Á∫°‘π«à“ ç∑Ë¥’ π‘
·ª≈ß∑Ë’·¬°‰ªπ’Èæâπ®“° ‘∑∏‘‡°Á∫°‘πμ“¡∫—π∑÷°¢âÕμ°≈ߪ≈Õ¥ ‘∑∏‘‡°Á∫°‘π©∫—∫
≈ß«—π∑’Ë...........‡¥◊Õπ.....................æ.».....  à«π∑Ë’¥‘π·ª≈ߧ߇À≈◊Õ ¬—ߧߡ’
 ‘∑∏‘‡°Á∫°‘π§√Õ∫μ‘¥Õ¬àŸμ“¡∫—π∑÷°¢âÕμ°≈ß ‘∑∏‘‡°Á∫°‘π ©∫—∫≈ß«—π∑’Ë.........
‡¥Õ◊ π........æ.».....é (μ“¡μ—«Õ¬“à ßÀ¡“¬‡≈¢ ˆ)

¢Õâ ÒÚ ‡¡Ë◊Õ‰¥â®¥∑–‡∫’¬π ‘∑∏‘‡°Á∫°‘π‰«â·≈â« ·≈– ‘∑∏‘‡°Á∫°‘ππ—Èπ¬—ß ‡≈‘° ‘∑∏‡‘ °∫Á °‘π°Õà π
‰¡àæâπ°”À𥇫≈“ À“°§àŸ°√≥’ª√– ß§å®–‡≈‘° ‘∑∏‘‡°Á∫°‘πμàÕ°—π °Á„Àâ∑È—ß Õß °”Àπ¥

› ¡μ’ «— Õ¬à“ß∑Ë’ ˜

ΩÉ“¬∑”∫—π∑÷°¢âÕμ°≈ß·≈–®¥∑–‡∫’¬π‡≈‘° ‘∑∏‘‡°Á∫°‘π ∂â“ ‘∑∏‘‡°Á∫°‘πæâπ
°”À𥇫≈“·≈â« „Àâ∂◊Õ«à“ ‘∑∏‘‡°Á∫°‘π‡ªìπÕ—π ‘Èπ‰ª‚¥¬¡‘μâÕß®¥∑–‡∫’¬π
‡≈‘° ‘∑∏‡‘ °Á∫°π‘ Õ°’ (μ“¡μ«— Õ¬“à ßÀ¡“¬‡≈¢ ˜)

¢âÕ ÒÛ °√≥’∑Ë’ºâŸ∑√ß ‘∑∏‘‡°Á∫°‘π∂÷ß·°à§«“¡μ“¬ Õ—π‡ªìπ‡Àμÿ„Àâ °√≥’ºâŸ∑√ß ‘∑∏‘쓬
 ‘∑∏‘‡°∫Á °π‘ μâÕß È‘π‰ªμ“¡¡“μ√“ ÒÙÒ¯ ·Ààߪ√–¡«≈°ÆÀ¡“¬·æàß·≈–æ“≥‘™¬å ‡≈‘° ‘∑∏‘‡°Á∫°‘π

› ¡μ’ «— Õ¬“à ß∑Ë’ ¯

„À⮥∫—π∑÷°∂âÕ¬§”‡®â“¢Õß∑Ë’¥‘π¥â«¬·∫∫æ‘¡æå∫—π∑÷°∂âÕ¬§” (∑.¥.Òˆ) ∂÷߇Àμÿ
∑’Ë∑”„Àâ ‘∑∏‘‡°Á∫°‘πμâÕß ‘Èπ‰ª‚¥¬¬◊ËπÀ≈—°∞“π¡√≥∫—μ√À√◊Õ§” —Ëß»“≈À√◊Õ欓π
À≈°— ∞“πÕπË◊ ∑‡Ë’ ™◊ÕË ∂Õ◊ ‰¥â √—∫√Õß«à“ºâ∑Ÿ √ß ‘∑∏‘‡°Á∫°‘π‰¥μâ “¬®√ß‘ ®ß÷ „À⮥∑–‡∫¬’ π
‡≈°‘  ‘∑∏‡‘ °∫Á °‘π‰¥â (μ“¡μ«— Õ¬“à ßÀ¡“¬‡≈¢ ¯)

¢âÕ ÒÙ °àÕ𥔇π‘π°“√®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡‡°’ˬ«°—∫∑’Ë¥‘π °“√∫—π∑÷°√“¬°“√
∑Ë’¡’Àπ—ß ◊Õ· ¥ß ‘∑∏‘„π∑Ë’¥‘π„Àâæπ—°ß“π‡®â“Àπâ“∑Ë’·°â∑–‡∫’¬π„π “√∫—≠ ®¥∑–‡∫’¬π
® ¥ ∑ – ‡ ∫’ ¬ π ‚ ¥ ¬ „ Àâ ® ¥ ∫— π ∑÷ °   “ √ –  ” §— ≠ ≈ ß „ π À π— ß  ◊ Õ ·   ¥ ß  ‘ ∑ ∏‘ „ π ∑Ë’ ¥‘ π
©∫—∫ ”π°— ß“π∑’Ë¥π‘ ·≈–©∫—∫‡®“â ¢Õß∑Ë¥’ π‘ „Àâμ√ß°—π¥«â ¬

¢âÕ Òı °“√·°â∑–‡∫’¬π„π “√∫—≠®¥∑–‡∫’¬π „π™àÕߺ⟄Àâ —≠≠“„Àâ °“√·°∑â –‡∫¬’ π
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°—∫∑’ˉ¥°â ≈“à «¡“¢“â ßμπâ

ıÛ

(Û) μ√«® Õ∫∫—≠™’Õ“¬—¥«à“¡’°“√Õ“¬—¥∑Ë’¥‘πÀ√◊ÕÕ —ßÀ“√‘¡∑√—æ¬å∑’Ë μ√«®Õ“¬—¥
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À¡«¥ Ù
§à“∏√√¡‡π’¬¡

¢Õâ Úˆ °“√®¥∑–‡∫’¬π ‘∑∏‘‡°Á∫°‘π∑’Ë¡’§à“μÕ∫·∑π‡ªìπ°“√ ‡°∫Á §à“∏√√¡‡π¬’ ¡
®¥∑–‡∫’¬π∑Ë’¡’∑ÿπ∑√—æ¬å„Àâæπ—°ß“π‡®â“Àπâ“∑Ë’‡√’¬°‡°Á∫§à“∏√√¡‡π’¬¡‚¥¬∂◊Õ μ“¡°Æ°√–∑√«ß
‡Õ“§à“μÕ∫·∑π∑Ë’§Ÿà°√≥’μ°≈ß™”√–·°à°—π‡ªìπ√“§“ª√–‡¡‘π∑ÿπ∑√—æ¬å  à«π
°“√®¥∑–‡∫’¬π ‘∑∏‘‡°Á∫°‘π‚¥¬‰¡à¡’§à“μÕ∫·∑π‡ªìπ°“√®¥∑–‡∫’¬πª√–‡¿∑
‰¡à¡’∑ÿπ∑√—æ¬å „Àâ‡√’¬°‡°Á∫§à“∏√√¡‡π’¬¡ª√–‡¿∑‰¡à¡’∑ÿπ∑√—æ¬å ∑È—ßπÈ’ μ“¡
°Æ°√–∑√«ß´÷ËßÕÕ°μ“¡§«“¡„πæ√–√“™∫—≠≠—μ‘„Àâ„™âª√–¡«≈°ÆÀ¡“¬∑’Ë¥‘π
æ.».ÚÙ˘˜

ª√–°“» ≥ «—π∑’Ë ÒÛ °π— ¬“¬π æ.».ÚıÙ˘
(≈ß™ÕË◊ ) æ√’ æ≈ ‰μ√∑»“«‘∑¬å
(π“¬æ√’ æ≈ ‰μ√∑»“«∑‘ ¬å)
Õ∏‘∫¥°’ √¡∑Ë’¥π‘

ıÙ

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

∑ ’Ë «π/‰√à

∑’Ëπ“

∑’Ë..............

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

·≈–°“√ Õ∫ «π ‘∑∏‘„π∑’¥Ë ‘π ª√–‡¿∑.. ..∑‘..∏...‘‡.°..Á∫...°..‘π....(.¡..°’..”..À...π..¥........ªï) „π‡¢μ

μ”·Àπàß∑Ë’¥‘π

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

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

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

‚©π¥∑¥Ë’ π‘

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

Ò. ¢“â 懮⓺¡Ÿâ ’π“¡μÕà ‰ªπ’È ¡’§«“¡ª√– ß§å¢Õ®¥∑–‡∫’¬π ∑‘ ∏·‘ ≈–π‘μ‘°√√¡‡°’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“â „À∂â âÕ¬§”‰¡‡à ªì𧫓¡®√ß‘ „Àâ„™∂â Õâ ¬§”π’¬È —π¢“â 懮“â „π∑“ߧ¥Õ’ “≠“‰¥â

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

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

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

Õ¬àŸ∑’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.⟠...∑..√..ß.. ..∑‘...∏..‡‘ .°..∫Á...°..π‘.............

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

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

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

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

«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™◊ËÕ....................π..“..¬....°...........................ºâŸ¢Õ ∂◊Õ°√√¡ ∑‘ ∏‘Ï
≈ß™ÕË◊ ....................π..“..¬....¢...........................ºŸâ¢Õ ∑√ß ∑‘ ∏‡‘ °∫Á °π‘
≈ß™◊ÕË ......................................................º âŸ Õ∫ «π

(......................................................)
 ”À√—∫æπ—°ß“π‡®â“Àπ“â ∑’Ë
Ò) √“§“ª√–‡¡‘π∑ÿπ∑√æ— ¬.å ....................................................................................................∫“∑........................................ μ“ߧå
Ú) ‚©π¥∑Ë’¥‘π„À¡√à –«“ß............................................‡≈¢∑¥’Ë π‘ ...............................................Àπ“â  ”√«®.........................................
‚©π¥∑’¥Ë ‘π‡≈¢∑’.Ë ..................................................‡≈à¡......................................................Àπâ“..................................................
®”π«π∑¥Ë’ π‘ ......................................................‰√.à ................................................ß“π..................................................μ“√“ß«“
§ß‡À≈Õ◊ ...........................................................‰√.à ................................................ß“π..................................................μ“√“ß«“
Û) ‰¥â®¥∑–‡∫¬’ π·≈â«·μ«à —π∑Ë.’ ................................‡¥Õ◊ π............................................æ.»......................

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

μ—«Õ¬à“ßÀ¡“¬‡≈¢ Ò ıı

(∑.¥. Òˆ)

∫—π∑÷°¢âÕμ°≈ß ‘∑∏‡‘ °∫Á °π‘

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

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

‡≈¢ª√–®”μ—«ª√–™“™π

¢“â 懮“â ..........π..“..¬....°......º..∂Ÿâ..Õ◊...°..√..√..¡.. ...∑‘ ..∏..Ï‘....................................................

..........π..“..¬....¢.......º..Ÿâ∑..√..ß.. ...‘∑..∏..‘‡..°..∫Á ..°..‘π...................................................

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

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

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

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

......................¢..âÕ....Ò......∑...’¥Ë ..π‘...·..ª...≈..ß..‡..§..√..ÕË◊...ß..À..¡...“..¬..¥...ß— ..°..≈...à“..«..¢..â“..ß..∫...π..π...È’ .´...Ë÷ß..¡..’™...◊ÕË ..¢..“â..æ...‡.®..“â....π..“..¬....°.....‡.ª...πì ..º...∂Ÿâ ..◊Õ...°..√..√..¡... ..‘∑...∏..Ï‘.‰..¥..â¬...π‘ ..¬...Õ..¡...„.À...â .π...“.¬....¢.........
.‡.ª..ìπ...º..∑âŸ...√..ß.. ...∑‘ ..∏..‘‡..°..∫Á...°..‘π....¡.. ’...∑‘..∏...§‘ ..√..Õ...∫..§...√..Õ..ß....„..™..â·..≈...–..∂..◊Õ...‡.Õ...“.ª...√..–..‚..¬..™..π...å·..À...ßà ..∑..√...—æ..¬... å ..π‘...„.π..∑...¥’Ë ..‘π...·..ª...≈..ß..π...’ȉ..¥..â..¡..°’..”..À...π..¥.....................................ª..ï..·..≈...–..¢..â“..æ...‡.®..“â.....
.π..“..¬....¢.....¬...Õ..¡...√..—∫.. ...∑‘..∏...‡‘ .°..Á∫...°..π‘...®..“..°....π..“..¬....°......¥..—ß...°..≈..“à..«..·...≈..â«..............................................................................................................................
......................¢..Õâ....Ú.......°...“..√..¢..Õ...®..¥..∑...–..‡.∫...’¬..π... ..‘∑...∏..‡‘.°...∫Á ..°...π‘ ..¥...ß— ..°..≈...“à ..«..‰.¡...à¡..’§...“à .μ...Õ..∫...·..∑...π....(.¡...’§..à“..μ...Õ..∫...·..∑...π..‡.ª...ìπ..‡..ß..‘π...................................................................∫..“..∑...)...............
......................¢..Õâ....Û.......¢...“â ..æ..‡..®..“â ..¬..Õ...¡..‡. ...¬’ ..§...à“..∏..√..√..¡...‡.π...’¬..¡..μ...“..¡..√...–..‡.∫...¬’ ..∫.............................................................................................................
......................∫...—π..∑...°÷ ..¢..âÕ...μ..°...≈..ß..π...∑’È ..”..‰..«..â .Ò....©...∫..∫—....‡..°..∫Á...‰.«..â..≥..... ..”..π..—°...ß..“..π..∑...Ë’¥..‘π....¢...â“..æ..‡..®..â“..∑..Èß—.. ...Õ..ß..Ω...É“..¬..‰..¥..âμ...√..«..®..∫...π— ..∑...÷°..¢..Õâ...μ..°...≈..ß..·...≈..–..‡..¢..â“..„.®..¢...âÕ..§...«..“..¡.
μ...≈..Õ...¥..·...≈..«â....®..ß÷..≈...ß..≈..“..¬...¡..◊Õ...™..Ë◊Õ..‰..«..‡â .ª...ìπ..À...≈..—°...∞..“..π..μ...Õà ..À...π..“â..æ...¬..“..π..·...≈..–..‡..®..â“..æ...π..—°..ß...“..π..∑...Ë¥’ ..‘π........................................................................................

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

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ıˆ

μ«— Õ¬à“ßÀ¡“¬‡≈¢ Ò

 “√∫≠— ®¥∑–‡∫¬’ π

®¥∑–‡∫’¬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 ....................  ‘∑∏‘‡°∫Á °π‘ 𓬠°. 𓬠¢. Ò › › › › › › (≈ß™◊ËÕ).........................
‡¥Õ◊ π................... (¡’°”Àπ¥..............ª)ï ºŸ∑â √ß ∑‘ ∏‡‘ °∫Á °‘π
æ.». .....................

ı˜

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

∑Ë’ «π/‰√à

∑Ë’π“

∑’.Ë .............

§”¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–πμ‘ ‘°√√¡ πÕ°‡¢μ

„π‡¢μ

·≈–°“√ Õ∫ «π ‘∑∏‘„π∑Ë’¥π‘ ª√–‡¿∑.. ..∑‘ ..∏..‡‘..°..∫Á ..°...‘π...(..μ..≈..Õ...¥..™..’«..‘μ..¢...Õ..ß..º..∑âŸ...√..ß.. ..‘∑∏‘‡°Á∫°‘π)

μ”·Àπàß∑Ë’¥‘π

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

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

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

‚©π¥∑’Ë¥π‘

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

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

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

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

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

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

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

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

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

º.⟠...∑..√..ß.. ..∑‘...∏..‡‘ .°..∫Á...°..π‘.............

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

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

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

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

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

ı. ¢“â 懮“â ¢Õ√∫— √Õß«“à (À“â · π∫“∑∂«â π)

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

(Ú) √“§“∑√—æ¬å∑Ë’· ¥ß‰«â„π Ù. ‡ªπì √“§“∑Ë’·∑®â √‘ß
(Û) . ..‘∑..∏..‡‘..°..Á∫..°...π‘ ..μ..≈...Õ..¥..™..«’..μ‘...¢..Õ..ß..º...â∑Ÿ ..√..ß.. ..‘∑...∏..‡‘ .°..Á∫...°..‘π.....................................................................................................

(Ù) .‰.¡..¡à...§’ ..à“..μ..Õ...∫..·..∑...π..............................................................................................................................................

(ı) .....................................................................................................................................................................

«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
≈ß™ÕË◊ ....................π..“..¬....°...........................ºâŸ¢Õ ∂Õ◊ °√√¡ ‘∑∏Ï‘
≈ß™Ë◊Õ....................π..“..¬....¢...........................ºŸâ¢Õ ∑√ß ∑‘ ∏‡‘ °∫Á °π‘

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

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

 ”À√∫— æπ°— ß“π‡®â“Àπâ“∑Ë’

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

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

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

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

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

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

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

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

‡®â“æπ—°ß“π∑Ë’¥‘π

ı¯

μ«— Õ¬“à ßÀ¡“¬‡≈¢ Ú

(∑.¥. Òˆ)

∫—π∑°÷ ¢Õâ μ°≈ß ∑‘ ∏‡‘ °∫Á °‘π

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

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

‡≈¢ª√–®”μ—«ª√–™“™π

¢“â 懮“â ..........π..“..¬....°......º..∂âŸ..◊Õ...°..√..√..¡.. ...‘∑..∏..Ï‘....................................................

..........π..“..¬....¢.......º..Ÿ∑â ..√..ß.. ...‘∑..∏..‘‡..°..Á∫..°..π‘...................................................

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

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

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

¥//«â//¬//§//«/“/¡// //—μ//¬//®å /√//ß‘ / ¥ß— μÕà ‰ªπ’È :›

......................¢..Õâ....Ò......∑...’¥Ë ..π‘...·..ª...≈..ß..‡..§..√..ËÕ◊...ß..À..¡...“..¬..¥...—ß..°..≈...à“..«..¢..“â..ß..∫...π..π...È’ .´...Ë÷ß..¡..’™...◊ËÕ..¢..â“..æ...‡.®..â“....π..“..¬....°.....‡.ª...ìπ..º...â∂Ÿ ..Õ◊...°..√..√..¡... ..∑‘...∏..‘Ï.‰..¥..¬â...π‘ ..¬...Õ..¡...„.À...â .π...“.¬....¢.........
.‡.ª..πì...º..∑Ÿâ...√..ß.. ...‘∑..∏..‘‡..°..Á∫...°..‘π....¡..’ ...‘∑..∏...§‘ ..√..Õ...∫..§...√..Õ..ß....„..™..·â ..≈...–..∂..Õ◊...‡.Õ...“.ª...√..–..‚..¬..™..π...å·..À...àß..∑..√...æ— ..¬... å ..‘π...„.π..∑...’¥Ë ..π‘...·..ª...≈..ß..π...È’‰..¥..â®..π...μ..≈...Õ..¥...™..«’..μ‘...¢..Õ..ß..π...“..¬....¢.....º...â∑Ÿ..√...ß.. ..∑‘...∏.‘
.‡.°..Á∫...°..π‘....·...≈..–..¢..“â..æ...‡.®...â“...π...“.¬....¢......¬..Õ...¡..√..—∫... ..‘∑...∏..‡‘..°..Á∫...°..‘π..®...“..°...π...“..¬....°.....¥...—ß..°...≈..à“..«..·..≈...â«...‚..¥..¬...‰.¡...à¡..§’...“à ..μ..Õ...∫..·...∑..π...........................................................
......................¢..Õâ....Ú.......¢...â“..æ..‡..®..â“..¬..Õ...¡..‡. ...’¬..§...à“..∏..√..√..¡...‡.π...¬’ ..¡..μ...“..¡..√...–..‡.∫...¬’ ..∫.............................................................................................................
......................∫...π— ..∑...÷°..¢..âÕ...μ..°...≈..ß..π...È’∑..”..‰..«..â .Ò....©...∫..—∫....‡..°..∫Á...‰.«..â..≥..... ..”..π..—°...ß..“..π..∑...¥Ë’ ..π‘....¢...“â ..æ..‡..®..â“..∑..Èß—.. ...Õ..ß..Ω...É“..¬..‰..¥..μâ...√..«..®..∫...π— ..∑...°÷ ..¢..âÕ...μ..°...≈..ß..·...≈..–..‡..¢..“â ..„.®..¢...âÕ..§...«..“..¡.
μ...≈..Õ...¥..·...≈..â«....®..ß÷ ..≈...ß..≈..“..¬...¡..◊Õ...™..Ë◊Õ..‰..«..â‡.ª...ìπ..À...≈..°— ...∞..“..π..μ...àÕ..À...π..“â ..æ...¬..“..π..·...≈..–..‡..®..â“..æ...π..—°..ß...“..π..∑...’Ë¥..π‘ ........................................................................................

.................................................................................................................................................................................................................
............................................................................................≈..ß...™..Ë◊Õ...........................................................π......“....¬.........°.......................................................º..â∂Ÿ...Õ◊ ..°...√..√..¡.. ...‘∑..∏...Ï‘ ..........................
............................................................................................≈..ß...™..Ë◊Õ...........................................................π......“....¬.........¢......................................................º..âŸ∑...√..ß.. ...∑‘ ..∏..‘‡..°..Á∫...°..π‘.........................
............................................................................................≈..ß...™..Ë◊Õ....................................................................................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..◊ËÕ.....................................................................................................................................æ...¬..“..π...........................................
.............................∫...π—..∑...÷°..¢...Õâ ..μ...°..≈..ß..π...È’‰..¥..∑â...”..μ..Õà...À..π...“â ......................................................................................................................................
............................................................................................≈..ß...™..Ë◊Õ.....................................................................................................................................‡.®..“â..æ...π...°— ..ß..“..π..∑...¥’Ë..π‘..........................
..........................................................................................................ª..√..–..∑...—∫..μ...√..“..μ...”.·...À..π...àß..‡.ª...ìπ.. ...”..§..—≠..........................................................

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μ«— Õ¬“à ßÀ¡“¬‡≈¢ Ú

 “√∫≠— ®¥∑–‡∫¬’ π

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

«π— ∑.’Ë ....................  ‘∑∏‘‡°∫Á °‘π 𓬠°. 𓬠¢. Ò › › › › › › (≈ß™Ë◊Õ).........................
‡¥◊Õπ................... (μ≈Õ¥™«’ ‘μ¢Õß º∑⟠√ß ∑‘ ∏‡‘ °Á∫°‘π
æ.»...................... ºâ∑Ÿ √ß ∑‘ ∏‡‘ °∫Á °π‘ )

ı˘

ˆ

μ—«Õ¬“à ßÀ¡“¬‡≈¢ Û (∑.¥. Ò)
∑∫Ë’ “â π

∑ ’Ë «π/‰√à

∑’Ëπ“

∑’.Ë .............

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

·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑’¥Ë ‘π ª√–‡¿∑.. ..‘∑..∏..‡‘..°..∫Á ..°...π‘ ..‡.©..æ...“..–.. ..«à..π....(.¡..’°...”.À...π..¥.............ª)ï

μ”·Àπàß∑Ë’¥‘π (À√◊Õμ≈Õ¥™«’ ‘μ¢ÕߺŸâ∑√ß ‘∑∏‡‘ °Á∫°π‘ )

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

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

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

‚©π¥∑¥Ë’ π‘

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

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

𓬠°. „Àâ𓬠§. ‡ªìπºâŸ∑√ß ‘∑∏‘‡°Á∫ ‘°π‡©æ“– à«π¢Õßμπ‡∑à“π—Èπ  à«π¢Õß𓬠¢. §ß‡¥‘¡‰¥ªâ Ø≠‘ “≥μπ·≈â« ¢Õ„À∂â âÕ¬§”¥â«¬§«“¡ —μ¬å®√ß‘ ∂“â ¢“â 懮ⓄÀâ∂Õâ ¬§”‰¡à‡ªì𧫓¡®√‘ß„Àâ„™â∂Õâ ¬§”π’¬È —π¢“â 懮“â „π∑“ߧ¥Õ’ “≠“‰¥â
‡ â®“æ —π°ß“π ’Ë∑ ‘¥π
Ú. ¢â“懮“â ..............Ò.....π...“.¬....°....................... ‡≈¢ª√–®”μ—«ª√–™“™π ºâŸ...∂..Õ◊..°...√..√..¡.. ..‘∑...∏..‘Ï ...............

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

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

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

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

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

º.⟠...∑..√..ß.. ..∑‘...∏..‡‘ .°..∫Á...°..π‘.............

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

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

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

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

«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™◊ÕË ....................π..“..¬....°...........................ºâŸ¢Õ ∂◊Õ°√√¡ ‘∑∏‘Ï
≈ß™◊ËÕ....................π..“..¬....¢...........................ºâŸ¢Õ ∑√ß ∑‘ ∏‡‘ °∫Á °π‘
≈ß™Õ◊Ë ......................................................º Ÿâ Õ∫ «π

(......................................................)
 ”À√∫— æπ—°ß“π‡®“â Àπ“â ∑Ë’
Ò) √“§“ª√–‡¡π‘ ∑πÿ ∑√æ— ¬.å ....................................................................................................∫“∑........................................ μ“ߧå
Ú) ‚©π¥∑’¥Ë π‘ „À¡à√–«“ß............................................‡≈¢∑’Ë¥‘π...............................................Àπâ“ ”√«®.........................................
‚©π¥∑¥Ë’ ‘π‡≈¢∑Ë.’ ..................................................‡≈¡à ......................................................Àπâ“..................................................
®”π«π∑¥Ë’ π‘ ......................................................‰√.à ................................................ß“π..................................................μ“√“ß«“
§ß‡À≈Õ◊ ...........................................................‰√.à ................................................ß“π..................................................μ“√“ß«“
Û) ‰¥â®¥∑–‡∫¬’ π·≈â«·μà«π— ∑.’Ë ................................‡¥◊Õπ............................................æ.»......................

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

μ«— Õ¬“à ßÀ¡“¬‡≈¢ Û ˆÒ

(∑.¥. Òˆ)

∫π— ∑°÷ ¢Õâ μ°≈ß ‘∑∏‘‡°∫Á °π‘ ‡©æ“– à«π

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

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

‡≈¢ª√–®”μ—«ª√–™“™π

¢“â 懮“â ..........π..“..¬....°......º..â∂Ÿ..Õ◊...°..√..√..¡.. ...‘∑..∏..‘Ï....................................................

..........π..“..¬....§.......º..∑Ÿâ..√..ß.. ...∑‘ ..∏..‘‡..°..Á∫..°..‘π...................................................

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

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

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

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

¥//â«//¬//§//«/“/¡// //—μ//¬//å®/√//ß‘ / ¥ß— μÕà ‰ªπÈ’ :›
......................¢..Õâ....Ò.......∑...¥Ë’ ..‘π...·..ª...≈..ß..‡..§..√..ËÕ◊...ß..À..¡...“..¬..¥...ß— ..°..≈...“à ..«..¢..â“..ß..∫...π..π...’È .´...Ëß÷ ..¡..™’...Õ◊Ë ..π..“..¬....°......π..“..¬....¢......‡.ª...ìπ..º...∂Ÿâ ..◊Õ...°..√..√..¡... ..∑‘...∏..Ï‘.‡..©..æ...“..–.. ..à«...π..¢..Õ...ß..¢..â“..æ...‡.®..â“.....
.π..“..¬....°......¬..π‘..¬...Õ..¡...„.À...â .π...“..¬....§.....‡..ª..πì...º..âŸ∑...√..ß.. ..‘∑...∏..‘‡..°..∫Á...°..π‘....¡.. ’...∑‘ ..∏...§‘ ..√..Õ...∫..§...√..Õ..ß....„.™...·â ..≈...–..∂..◊Õ...‡.Õ..“..ª...√..–..‚..¬..™..π...å·..À...àß..∑..√..—æ...¬.. å...‘π..„..π..∑...’Ë¥..‘π...·..ª...≈..ß..π...’ȉ.¥...â.............
.¡..°’..”..À...π..¥.....................................ª..ï..(.À...√..Õ◊ ..μ...≈..Õ...¥..™..’«...μ‘ ..¢..Õ...ß..º..Ÿ∑â...√..ß.. ...‘∑..∏..‡‘..°..∫Á...°..π‘...)..·...≈..–..¢...“â ..æ..‡..®..â“...π...“..¬....§......¬..Õ..¡...√..—∫... ..‘∑..∏...‡‘ .°...Á∫..°..π‘...‡.©...æ..“..–.. ...à«..π..¢...Õ..ß....π..“..¬....°...............
¥...—ß..°...≈..à“..«..·..≈...â«..............................................................................................................................................................................................
......................¢..âÕ....Ú.......°...“..√..¢..Õ...®..¥..∑...–..‡.∫...¬’ ..π... ..∑‘...∏..‘‡.°...∫Á ..°...π‘ ..¥...ß— ..°..≈...“à ..«..‰.¡...¡à ..’§...à“.μ...Õ..∫...·..∑...π....(.¡...§’ ..à“..μ...Õ..∫...·..∑...π..‡.ª...ìπ..‡..ß..‘π......................................∫...“..∑..)............................
......................¢..âÕ....Û.......¢...“â ..æ..‡..®..“â ..¬..Õ...¡..‡. ...’¬..§...“à ..∏..√..√..¡...‡.π...’¬..¡..μ...“..¡..√...–..‡.∫...¬’ ..∫.............................................................................................................
......................∫...—π..∑...÷°..¢..Õâ...μ..°...≈..ß..π...∑’È ..”..‰..«..â .Ò....©...∫..—∫....‡..°..Á∫...‰.«..â..≥..... ..”..π..—°...ß..“..π..∑...’Ë¥..‘π....¢...“â ..æ..‡..®..â“..∑..ßÈ—.. ...Õ..ß..Ω...É“..¬..‰..¥..âμ...√..«..®..∫...—π..∑...°÷ ..¢..âÕ...μ..°...≈..ß..·...≈..–..‡..¢..â“..„.®..¢...âÕ..§...«..“..¡.
μ...≈..Õ...¥..·...≈..«â....®..ß÷..≈...ß..≈..“..¬...¡..◊Õ...™..ÕË◊ ..‰..«..â‡.ª...πì ..À...≈..—°...∞..“..π..μ...àÕ..À...π..“â..æ...¬..“..π..·...≈..–..‡..®..â“..æ...π..—°..ß...“..π..∑...Ë’¥..‘π........................................................................................

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............................................................................................≈..ß...™..Ë◊Õ...........................................................π......“....¬.........°.......................................................º..Ÿ∂â...◊Õ..°...√..√..¡.. ...‘∑..∏...‘Ï ..........................
............................................................................................≈..ß...™..Ë◊Õ...........................................................π......“....¬.........§.......................................................º..â∑Ÿ...√..ß.. ...∑‘ ..∏..‡‘..°..∫Á...°..‘π.........................
............................................................................................≈..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...ßà ..‡.ª...ìπ.. ...”..§..—≠..........................................................

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ˆÚ

μ—«Õ¬à“ßÀ¡“¬‡≈¢ Û

 “√∫—≠®¥∑–‡∫¬’ π

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

«π— ∑Ë’.....................  ‘∑∏‡‘ °Á∫°‘π Ò. 𓬠°. 𓬠§. Ò › › › › › › (≈ß™ÕË◊ ).........................
º∑Ÿâ √ß ‘∑∏‡‘ °Á∫°π‘ 𓬠°. „Àπâ “¬ §. ‡ªìπºâ∑Ÿ √ß ∑‘ ∏‡‘ °∫Á °π‘
‡¥◊Õπ................... ‡©æ“– «à π Ú. 𓬠¢.
‡©æ“– «à π„π∑Ë’¥π‘ ¢Õßμπ‡∑à“ππ—È  «à π¢Õß
æ.»...................... (¡’°”Àπ¥.............ªï) 𓬠¢. §ß‡¥¡‘

(À√◊Õμ≈Õ¥™’«‘μ¢Õß

º∑Ÿâ √ß ‘∑∏‡‘ °Á∫°π‘ )

ˆÛ

μ—«Õ¬à“ßÀ¡“¬‡≈¢ Ù (∑.¥. Ò)

(°√≥’√∫— ¡√¥°μ“¡∑’‡Ë ®“â ¢Õß∑¥Ë’ ‘π ∑∫’Ë “â π
∑Ë ’ «π/‰√à
∑”æ‘π¬— °√√¡„À â ‘∑∏‡‘ °∫Á °‘π ∑Ë’π“
Õπ— ‡ªìπ°“√‰¥¡â “´÷ßË  ∑‘ ∏‘‡°Á∫°‘π ∑’Ë..............
μ“¡æ‘π—¬°√√¡) πÕ°‡¢μ

§”¢Õ®¥∑–‡∫’¬π ‘∑∏·‘ ≈–πμ‘ ‘°√√¡ „π‡¢μ

μ”·Àπàß∑Ë’¥‘π ·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑’Ë¥‘π ª√–‡¿∑..‚.Õ..π...¡..√..¥..°..°...“..√..‰.¥..¡â...“.´...ßË÷ .. ..‘∑..∏..‘‡..°..Á∫..°...‘π...(..¡°’ ”Àπ¥.......ª)ï

(À√Õ◊ μ≈Õ¥™«’ μ‘ ¢Õߺ∑Ÿâ √ß ‘∑∏‘‡°∫Á °π‘ )

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

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

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

‚©π¥∑Ë¥’ ‘π

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

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

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

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

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

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

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

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

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

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

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

º.⟠...∑..√..ß.. ..∑‘...∏..‡‘ .°..∫Á...°..π‘.............

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

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

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

(Ò) ¢“â 懮Ⓣ¡à‰¥√â ∫— ‚Õπ·∑πÀ√◊Õ‡æ◊ÕË ª√–‚¬™π·å °à∫§ÿ §≈μ“à ߥ⓫
(Ú) √“§“∑√æ— ¬å∑Ë’· ¥ß‰«â„π Ù. ‡ªπì √“§“∑Ë’·∑â®√‘ß
(Û) π...“.¬....°....º...∂Ÿâ ..◊Õ..°...√..√..¡.. ..∑‘...∏..μÏ‘ ..“..¬..‡..¡..ËÕ◊ ..«..—π..∑...Ë’ ............‡.¥..◊Õ...π...........................æ...»..............................................................................
(Ù) π...“.¬....°....‰..¥..â∑...”.æ...π‘ ..¬—..°...√..√..¡..©..∫...∫— ..«..π—..∑...Ë’ ...........‡.¥...Õ◊ ..π.........................æ....»..................„..À..âπ..“..¬....¢....‡.ª...ìπ..º..∑Ÿâ...√..ß.. ..∑‘..∏...‡‘ .°..∫Á..°...‘π..................

¡...’°..”..À..π..¥...................ª..ï.(..À..√..Õ◊..μ...≈..Õ..¥...™..«’ ..μ‘ ..¢..Õ...ß..º..âŸ∑..√..ß.. ...∑‘ ..∏..‘‡..°..Á∫..°..π‘...)...............................................................................
«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................

≈ß™◊ËÕ.......................›...............................ºâŸ¢Õ ∂◊Õ°√√¡ ∑‘ ∏Ï‘
≈ß™Õ◊Ë ....................π..“..¬....¢...........................ºâŸ¢Õ ∑√ß ∑‘ ∏‡‘ °∫Á °π‘
≈ß™Õ◊Ë ......................................................º Ÿâ Õ∫ «π

(......................................................)
 ”À√—∫æπ—°ß“π‡®“â Àπ“â ∑’Ë
Ò) √“§“ª√–‡¡‘π∑πÿ ∑√æ— ¬å.....................................................................................................∫“∑........................................ μ“ߧå
Ú) ‚©π¥∑Ë’¥‘π„À¡à√–«“ß............................................‡≈¢∑¥Ë’ π‘ ...............................................Àπ“â  ”√«®.........................................
‚©π¥∑’Ë¥π‘ ‡≈¢∑’.Ë ..................................................‡≈¡à ......................................................Àπâ“..................................................
®”π«π∑¥Ë’ π‘ ......................................................‰√.à ................................................ß“π..................................................μ“√“ß«“
§ß‡À≈Õ◊ ...........................................................‰√.à ................................................ß“π..................................................μ“√“ß«“
Û) ‰¥®â ¥∑–‡∫’¬π·≈«â ·μà«—π∑’Ë.................................‡¥Õ◊ π............................................æ.»......................

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

ˆÙ

μ«— Õ¬à“ßÀ¡“¬‡≈¢ Ù

(∑.¥. ¯)

·∫∫∫π— ∑°÷ °“√ Õ∫ «π¢Õ®¥∑–‡∫¬’ π‚Õπ¡√¥°
ª√–‡¿∑..‚.Õ..π...¡..√..¥..°..°...“..√..‰.¥..¡â...“.´...÷Ëß.. ..‘∑..∏..‡‘..°..Á∫..°...‘π...(..¡.°’ ”Àπ¥.................ªï

∑’Ë¥‘π (À√◊Õμ≈Õ¥™’«μ‘ º∑Ÿâ √ß ‘∑∏‡‘ °Á∫°π‘ )
√–«“ß..................................................................................μ”∫≈...................................................................................
‡≈¢∑’¥Ë π‘ ...........................................Àπ“â  ”√«®.....................................Õ”‡¿Õ................................................................

}‚©π¥

π. .Û ‡≈¢∑.Ë’ ..................................................................®—ßÀ«—¥..............................................................................
„∫‰μà «π

«—π∑Ë.’ ................‡¥◊Õπ.........................................æ∑ÿ ∏»—°√“™.........................

{ }...................................................................... ‡≈¢ª√–®”μ—«ª√–™“™π } { }................
Õ“¬ÿ .....Ù..ı......... ªï
¢“â 懮“â ............................π..“..¬...¢................................... ................
......................................................................
 ≠— ™“μ.‘ .........‰..∑..¬......................∫¥‘ “/¡“√¥“™ÕË◊ ................................................................................................................................

Õ¬à∑Ÿ ∫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„Àâ∂âÕ¬§”μÕà .......‡..®..“â ..æ..π..—°...ß..“.π...∑..¥’Ë...‘π..®..—ß..À..«..¥—.........................¥—ßμàÕ‰ªπ’È

∑Èß—  ÕßΩ“É ¬‰¥μâ °≈ß —≠≠“°—π¥—ßμàÕ‰ªπ’È
¢âÕ Ò. ¥«â ¬......π...“.¬....°...................................................................................................... ≠— ™“μ‘.....‰.∑..¬........................
´Ë÷߇ªπì ......º..∂⟠..◊Õ..°...√..√..¡.. ..‘∑...∏..‘Ï .............................................................∑’Ë¥π‘ ·ª≈ßÀ¡“¬‡≈¢¢“â ßμπâ πÈ’ ‰¥â.....μ..“..¬.........................................
‡¡Õ◊Ë .........«..—π...∑..Ë’.Ò....∏....§......Ú..ı...Ù..ı...............................μ“¡À≈°— ∞“π...„.∫...¡..√..≥...∫...μ— ..√..‡.≈...¢..∑..Ë.’..............................©...∫..∫—...≈..ß..«..—π..∑...’Ë......................´ßË÷ ‰¥¬â π◊Ë ¡“æ√Õâ ¡π·È’ ≈«â

¢Õâ Ú. Àπ—ß ◊Õ· ¥ß ∑‘ ∏‘„π∑¥’Ë π‘ ·ª≈ßπÈ’ ‡«≈“π’Èμ°Õ¬°Ÿà —∫............................................................................................

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¢Õâ Û. ¢“â 懮“â ¢Õ„À⥔‡ππ‘ °“√®¥∑–‡∫¬’ π¡√¥°≈ß™◊ËÕ..¢..“â..æ..‡..®..â“.‡..ª..ìπ...º..∑Ÿâ ..√..ß.. ..‘∑...∏..‡‘.°...Á∫..°..π‘..¡...°’ ..”..À..π...¥...............ª..ï.(..À..√..Õ◊..μ...≈..Õ..¥...™..’«..‘μ..

.º..Ÿâ∑..√..ß.. ..‘∑...∏..‘‡.°...∫Á ..°..π‘...)..¥...â«..¬...................................................................................................................................................................
‚¥¬‡Àμºÿ ≈¥ß— πÈ’§◊Õ..π...“..¬...°.....º..â∂Ÿ..Õ◊...°..√..√..¡.. ..∑‘...∏..Ï‘‰..¥..â∑..”..æ...π‘ ..¬—..°..√..√..¡...„.À...â¢..“â .æ...‡.®..“â..‡.ª...ìπ..º...Ÿ∑â ..√..ß.. ..‘∑...∏..‡‘ .°..∫Á...°..‘π..„..π..∑..¥Ë’...π‘ ..·..ª...≈..ß..π..È’..‚.¥..¬...¡..°’..”..À..π...¥..‡.«..≈...“............ª..ï.
.(.À..√..◊Õ..μ...≈..Õ..¥...™..’«..‘μ..º...â∑Ÿ ..√..ß.. ..∑‘...∏..‘‡.°..Á∫...°..π‘..)...ª..√..“..°..Ø...μ..“..¡..æ...‘π..—¬...°..√..√..¡..©..∫...∫— ..≈..ß...«.π—...∑...Ë’.........‡.¥..◊Õ...π......................æ...».............´...ßË÷ ..‰.¥..¬â...Ëπ◊ ..¡..“..æ...√..âÕ..¡..°..∫—...§..”..¢..Õ...π..·’È ..≈..â«...

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¢Õâ Ù. .....................................................................................................................................................................

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

À¡“¬‡Àμÿ }(≈ß™◊ËÕ)..........................................................................
Ò. §”¢ÕπÈ’‰¡μà âÕß· ¥ß∫—≠™‡’ §√Õ◊ ≠“μ‘
‡πËÕ◊ ß®“°‡ªπì °“√√—∫¡√¥°°“√‰¥â¡“´÷ßË (≈ß™ÕË◊ )...............................π...“..¬...¢.................................... ºâŸ„À∂â Õâ ¬§”
 ∑‘ ∏‡‘ °Á∫°π‘ ‚¥¬æ‘π¬— °√√¡ (≈ß™Õ◊Ë )..........................................................................

Ú. μâÕß¡’°“√ª√–°“»¡√¥°¥â«¬ (≈ß™◊ËÕ).........................................................................º Ÿâ Õ∫ «π/∫—π∑°÷

μàÕÀπ“â .................................................................................æπ—°ß“π‡®â“Àπ“â ∑’Ë

μ—«Õ¬“à ßÀ¡“¬‡≈¢ Ù

 “√∫—≠®¥∑–‡∫¬’ π

®¥∑–‡∫’¬π ª√–‡¿∑°“√ ºŸâ„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◊ ™Õ◊Ë
‚©π¥∑’Ë¥π‘ „À¡à ª√–∑∫— μ√“
‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
«“ «“

«—π∑.Ë’ .................... ‚Õπ¡√¥°°“√‰¥â¡“ 𓬠°. 𓬠¢. Ò › › › › › › (≈ß™◊ËÕ).........................
º∑⟠√ß ∑‘ ∏‘‡°∫Á °π‘
‡¥◊Õπ................... ´÷Ëß ‘∑∏‘‡°Á∫°‘π (쓬)

æ.»...................... (¡’°”Àπ¥.............ªï)

(À√◊Õμ≈Õ¥™’«‘μ¢Õß

º∑Ÿâ √ß ‘∑∏‘‡°∫Á °π‘ )

À¡“¬‡Àμÿ √“¬°“√®¥∑–‡∫’¬ππ’‡È ªìπ°“√√∫— ¡√¥° ‘∑∏‘‡°Á∫°‘π‡∑à“πÈ—π ‰¡à„™à‡ªπì °“√‚Õπ¡√¥°„πμ—«∑¥’Ë ‘π·μàÕ¬à“ß„¥
©–πÈπ— ∑“¬“∑ÕËπ◊ ®ß÷  “¡“√∂√—∫¡√¥°∑’¥Ë ‘π·ª≈ßπÈ√’ –À«“à ß ∑‘ ∏‘‡°∫Á °‘π‰¥â

ˆı

ˆˆ

μ«— Õ¬“à ßÀ¡“¬‡≈¢ ı

(∑.¥. ˘)

§”¢Õ..·..∫...ßà ..·..¬..°...„.π...π..“..¡..‡..¥..‘¡....(.§...√..Õ..∫... ..∑‘..∏...‘‡.°..∫Á...°..π‘. )

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

∑Ë’¥‘π
√–«“ß............5..1..3..6...I..V....6..0..0.0..-..9............................................μ”∫≈.........................................................................................
‡≈¢∑’Ë.............Ò........................................Àπâ“ ”√«®.............Ò.....Ò................................Õ”‡¿Õ..................................................
‚©π¥À¡“¬‡≈¢∑.’Ë ........Ò.......................................................®—ßÀ«—¥.......................................................................................

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

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

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

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

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

.·..∫..ßà..·..¬...°..∑..¥’Ë...‘π..„.π...π..“..¡..‡.¥...‘¡..¢..Õ...ß..¢..“â ..æ..‡.®...“â .Õ...Õ..°..®..“..°..°...π— ..‡.ª...πì ...Ò....·..ª...≈..ß....‚.¥..¬...„.À..∑â...¥Ë’ ..‘π..·...ª..≈..ß..·...¬..°..‡.ª...ìπ..‚.©...π..¥..„..À..¡..à..·..≈..–..·...ª..≈..ß..§...ß..‡.À..≈...◊Õ.... ..‘∑..∏..‘‡..°..∫Á ..°..π‘....
.¬..—ß..§..ß..¡...Õ’ ..¬..μàŸ...“.¡...∫..π—..∑...°÷ ..¢..âÕ...μ..°..≈..ß.. ...∑‘ ..∏..‡‘..°..∫Á ..°..‘π....≈...ß..«..—π..∑..Ë.’......................‡.¥..Õ◊...π.....................................................æ....»..............................´...Ëß÷ ..¢..“â ..æ..‡.®...â“.®..–..‰..¥..πâ...”.™...à“.ß..·...º..π..∑...’Ë∑..”..°..“..√..√..ß— ..«..—¥.....
ª...°í ..À..≈...°— ..‡.¢..μ...„.À...â‡.ª..πì...°..“..√..·..π..àπ...Õ..π..μ...Õà ..‰.ª..................................................................................................................................................

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¢Õâ Ú. ©–ππÈ— ¢Õ„À‡â ®“â æπ°— ß“π∑¥Ë’ π‘ ....‚..ª..√..¥... ..ß—Ë ..„.À...‡â .®..â“..À..π...â“.∑...’ˉ.ª...∑..”..°..“..√..√..ß—..«..—¥..·...∫..àß..·..¬...°..„.À...â¢..â“..æ..‡.®..“â..μ...“..¡..§..«..“..¡..ª...√..–.. ..ß..§...¥å ..â«..¬.....

¢...“â .æ...‡.®..“â..¬..Õ...¡..‡. ...¬’ ..§..“à..∏..√..√..¡...‡.π..¬’...¡..μ..“..¡..√..–..‡..∫..’¬..∫.......................................................................................................................................

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.......................π..“..¬....°.......................... ºŸâ¢Õ
........................................................ 欓π
........................................................ 欓π

ˆ˜

μ«— Õ¬à“ßÀ¡“¬‡≈¢ ı (∑.¥. Ò)
∑∫Ë’ “â π

∑Ë ’ «π/‰√à

∑’Ëπ“

∑.Ë’ .............

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

·≈–°“√ Õ∫ «π ‘∑∏‘„π∑Ë¥’ ‘π ª√–‡¿∑..·..∫..ßà..·..¬...°..„.π...π..“..¡..‡.¥...‘¡....(.§..√..Õ...∫.. ..∑‘...∏..‘‡.°..∫Á..°‘π) ·¬° Ò

μ”·Àπàß∑Ë’¥‘π ·≈–·ª≈ߧ߇À≈Õ◊
√–«“ß.....................5..1.3..6....I.V....6..0..0..0..-.9............................................. μ”∫≈.........................................................................................

∑’Ë ‘¥π·ª≈ß∑Ë’·¬°‰ªπÈ’ ‘ ∑∏‘‡°Á∫°‘π¬—ߧߡ’Õ¬Ÿàμ“¡∫—π∑÷° â¢Õμ°≈ß ≈ß«—π∑’Ë..........‡¥◊Õπ...................æ.».............. ‡≈¢∑’Ë¥π‘ .................Ò....................................................................Õ”‡¿Õ........................................................................................
‡®â“æ —π°ß“π ’Ë∑ ‘¥π
Àπ“â  ”√«®..............Ò....Ò................................................................®ß— À«—¥........................................................................................

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

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

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

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

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

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

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

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

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

ºŸâ....¢..Õ..·..∫...àß.........................

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

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

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

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

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

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

≈ß™◊ËÕ....................π..“..¬....°...........................ºŸâ¢Õ ∂Õ◊ °√√¡ ∑‘ ∏‘Ï
≈ß™◊ËÕ....................π..“..¬....°...........................ºŸâ¢Õ ·∫àß
≈ß™ËÕ◊ ......................................................º Ÿâ Õ∫ «π

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

 ”À√—∫æπ—°ß“π‡®“â Àπâ“∑Ë’

Ò) √“§“ª√–‡¡π‘ ∑ÿπ∑√—æ¬.å ....................................................................................................∫“∑........................................ μ“ߧå
Ú) ‚©π¥∑¥Ë’ π‘ „À¡√à –«“ß......5..1.3..6....I.V....6..0..0..0..-.9...............‡≈¢∑¥’Ë π‘ .................Û..Û............................Àπâ“ ”√«®.........Û...Û.............................

‚©π¥∑Ë¥’ π‘ ‡≈¢∑Ë’.............ı..ı....................................‡≈à¡......................................................Àπ“â ..................................................
®”π«π∑¥’Ë π‘ ...................Ò...................................‰√.à .............................›...................ß“π...............................›...................μ“√“ß«“
§ß‡À≈Õ◊ ........................Ú...................................‰√.à .............................›...................ß“π...............................›...................μ“√“ß«“

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

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

μ«— Õ¬“à ßÀ¡“¬‡≈¢ ı ˆ¯

 “√∫≠— ®¥∑–‡∫’¬π

(√“¬°“√®¥∑–‡∫’¬π·ª≈߇¥¡‘ ‚©π¥∑’Ë Ò)

®¥∑–‡∫¬’ 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 𓬠°. μ“¡ —≠≠“ §ß‡À≈Õ◊ ‡≈¢∑Ë’¥‘π ≈ß≈“¬¡Õ◊ ™Õ◊Ë
‚©π¥∑Ë¥’ ‘π„À¡à ª√–∑∫— μ√“
«π— ∑.Ë’ ....................  ∑‘ ∏‘‡°∫Á °π‘ ‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
‡¥Õ◊ π................... «“ «“
æ.». .....................
𓬠¢. Û › › › › › › (≈ß™ËÕ◊ ) 𓬠 .
ºŸâ∑√ß ∑‘ ∏‡‘ °∫Á °‘π

«π— ∑Ë.’ .................... ·∫ßà ·¬°„ππ“¡‡¥‘¡ 𓬠°. 𓬠°. Ò › › Ú › › 5136IV6000-9 (≈ß™Ë◊Õ).........................

‡¥◊Õπ................... (§√Õ∫ ∑‘ ∏‡‘ °Á∫°‘π) ∑Ë’¥π‘ ·ª≈ß∑·Ë’ ¬°‰ªπ’·È ≈–∑’¥Ë ‘π·ª≈ߧ߇À≈Õ◊ ÛÛ

æ.». .....................  ‘∑∏‡‘ °∫Á °‘π¬ß— §ß¡’Õ¬Ÿàμ“¡∫π— ∑÷° ıı

¢âÕμ°≈ß ≈ß«—π∑.’Ë .....‡¥◊Õπ...............æ.». ....

μ—«Õ¬à“ßÀ¡“¬‡≈¢ ı (√“¬°“√®¥·®âß∑¥Ë’ π‘ ·ª≈ß∑Ë’·¬°‰ª„À¡à ‚©π¥∑Ë’ ıı)

 “√∫≠— ®¥∑–‡∫’¬π

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

«—π∑.Ë’ ....................  ‘∑∏‡‘ °Á∫°π‘ 𓬠°. 𓬠¢. Û › › › › › › (≈ß™ËÕ◊ ) 𓬠 .
º∑⟠√ß ‘∑∏‘‡°∫Á °‘π  ‘∑∏‘‡°∫Á °‘π¬ß— §ß¡’Õ¬Ÿàμ“¡∫—π∑°÷ ¢âÕμ°≈ß «π— ∑Ë’............................
‡¥Õ◊ π................... (§√Õ∫ ∑‘ ∏‘‡°Á∫°π‘ ) ‡¥◊Õπ..........................
©∫∫— ≈ß«π— ∑.’Ë .........‡¥◊Õπ.......................æ.». .... æ.». ............................
æ.». ..................... (≈ß™ËÕ◊ )......................

ˆ˘

˜

μ—«Õ¬à“ßÀ¡“¬‡≈¢ ˆ

(∑.¥. ˘)

§”¢Õ..·..∫...ßà ..·..¬..°...„.π...π..“..¡..‡..¥..¡‘....(.ª...≈..Õ...¥.. ..‘∑...∏..‘‡.°...Á∫..°..π‘. )

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

∑Ë’¥‘π
√–«“ß............5..1..3..6...I..V....6..0..0.0..-..9............................................μ”∫≈.........................................................................................
‡≈¢∑.Ë’ ............Ò........................................Àπ“â  ”√«®.............Ò.....Ò................................Õ”‡¿Õ..................................................
‚©π¥À¡“¬‡≈¢∑’Ë.........Ò.......................................................®—ßÀ«—¥.......................................................................................

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

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

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

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

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

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

¢âÕ Ò. ¥â«¬...¢...“â .æ...‡.®..“â..¡..’™...ÕË◊ ..‡.ª...ìπ..º..Ÿâ∂...Õ◊ ..°..√..√..¡.. ...‘∑..∏..‘Ï∑...¥’Ë ..‘π..·...ª..≈..ß..‡..§..√..ËÕ◊ ..ß..À...¡..“..¬..¢..“â..ß..∫...π..π..’È‚..¥..¬..À...π..ß— .. ..Õ◊...π..¢’È ..â“..æ..‡..®..“â ..¡..’§..«..“..¡..ª...√..–.. ..ß..§...å .....
®...–..·..∫..àß..·...¬..°..∑..Ë’¥...π‘ ..„.π...π..“..¡..‡..¥..‘¡..¢..Õ...ß..¢..“â..æ..‡..®..â“.Õ...Õ..°..®..“..°..°...π— ..‡.ª...πì ....Ò...·...ª..≈..ß....‚.¥..¬...„.À..∑â...Ë’¥..π‘..‡..©..æ...“.–.. ...«à ..π..∑..·Ë’...∫..àß..·..¬..°...Õ..Õ..°...‡.ª..πì...‚.©..π...¥..„.À...¡..à.ª...≈..Õ..¥...®..“..°.......
 ...∑‘ ..∏..‡‘..°..∫Á ..°..π‘...‰.¥...â .·..≈..–...·..ª..≈...ß..§..ß..‡.À...≈..Õ◊ ..¬..—ß...§..ß..¡..’ ...∑‘ ..∏..‡‘.°...∫Á ..°..π‘...Õ..¬..Ÿà..´..ßË÷ ..¢..â“..æ..‡..®..“â ..®..–..‰.¥..âπ...”..™..“à ..ß..·..º..π..∑...Ë’∑..”..°..“..√..√..—ß..«..—¥..ª...í°..À..≈...—°..‡.¢..μ...„.À..‡â..ª..πì..°...“..√..·..π..πà..Õ...π..μ..Õà...‰ª

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¢âÕ Ú. ©–ππ—È ¢Õ„À‡â ®“â æπ°— ß“π∑¥’Ë π‘ ....‚..ª..√..¥... ..Ë—ß..„.À...â‡.®..â“..À..π...“â .∑...Ë’‰.ª...∑..”..°..“..√..√..—ß..«..¥—..·...∫..ßà..·..¬...°..„.À...â¢..â“..æ..‡.®..“â..μ...“..¡..§..«..“..¡..ª...√..–.. ..ß..§...¥å ..â«..¬.....

.¢..â“.æ...‡.®..â“..¬..Õ...¡..‡. ...’¬..§..à“..∏..√..√..¡...‡.π..¬’...¡..μ..“..¡..√..–..‡..∫..’¬..∫.......................................................................................................................................

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

˜Ò

μ—«Õ¬à“ßÀ¡“¬‡≈¢ ˆ (∑.¥. Ò)
∑∫’Ë “â π

∑ Ë’ «π/‰√à

∑’Ëπ“

∑.Ë’ .............

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

·≈–°“√ Õ∫ «π ∑‘ ∏‘„π∑’Ë¥π‘ ª√–‡¿∑...·..∫..ßà..·..¬...°..„.π...π..“..¡..‡.¥...¡‘ ......................... ·¬° Ò

Ë’∑ ‘¥π·ª≈ß∑’Ë·¬°‰ªπÈ’‰ ⥠âæπ®“° ‘∑ ‘∏‡ Á°∫ ‘°π μ“¡∫—π∑÷°¢âÕμ°≈ߪ≈Õ¥ ‘∑∏‘‡°Á∫°‘π ©∫—∫≈ß«—π∑Ë’..........‡ ◊¥Õπ...................æ.»..............μ”·Àπàß∑’Ë¥‘π (ª≈Õ¥›§√Õ∫ ∑‘ ∏‡‘ °∫Á °π‘ ) ·≈–·ª≈ߧ߇À≈Õ◊
 à«π·ª≈ߧ߇À≈◊Õ ‘∑∏‘‡ Á°∫°‘π¬—ߧߡ’Õ Ÿ¬àμ“¡∫—π∑÷°¢âÕμ°≈ß ‘∑∏‘‡ Á°∫°‘π ©∫—∫≈ß«—π∑’Ë..........‡ ◊¥Õπ...................æ.».............. √–«“ß.....................5..1.3..6....I.V....6..0..0..0..-.9.............................................
‡®â“æπ—°ß“π Ë’∑ ‘¥π μ”∫≈.........................................................................................

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

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

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

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

‰¥ªâ Ø≠‘ “≥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Ⓞπ∑“ߧ¥Õ’ “≠“‰¥â

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

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

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

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.⟠...¢..Õ..·..∫...ßà .........................

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

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

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

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

≈ß™◊ËÕ....................π..“..¬....°...........................ºâŸ¢Õ ∂◊Õ°√√¡ ∑‘ ∏‘Ï
≈ß™◊ÕË ....................π..“..¬....°...........................ºâŸ¢Õ ·∫àß
≈ß™ÕË◊ ......................................................º âŸ 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..1.3..6....I.V....6..0..0..0..-.9...............‡≈¢∑’Ë¥‘π.................Û..Û............................Àπ“â  ”√«®.........Û...Û.............................

‚©π¥∑¥’Ë ‘π‡≈¢∑.Ë’ ............ı..ı....................................‡≈à¡......................................................Àπâ“..................................................
®”π«π∑¥Ë’ π‘ ...................Ò...................................‰√.à .............................›...................ß“π...............................›...................μ“√“ß«“
§ß‡À≈Õ◊ ........................Ú...................................‰√.à .............................›...................ß“π...............................›...................μ“√“ß«“

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

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

˜Ú

μ«— Õ¬“à ßÀ¡“¬‡≈¢ ˆ

(∑.¥. Òˆ)

∫—π∑°÷ ¢Õâ μ°≈ߪ≈Õ¥ ‘∑∏‘‡°∫Á °‘π

∑Ë’¥‘π
√–«“ß................5..1..3..6...I..V....6..0.0..0..-..9.......................................μ”∫≈........................................................................
‡≈¢∑’¥Ë ‘π.............Ò..................Àπâ“ ”√«®......Ò.....Ò.................Õ”‡¿Õ.......................................................................
‚©π¥À¡“¬‡≈¢∑’Ë............Ò...................................................®—ßÀ«¥— .......................................................................

∑«’Ë à“°“√.....................................................................

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

‡≈¢ª√–®”μ—«ª√–™“™π

¢“â 懮“â ..........π..“..¬....¢.......º..âŸ∑..√..ß.. ...∑‘ ..∏..‡‘..°..∫Á ..°..‘π...................................................

..........π..“..¬....°.......º..Ÿ∂â..◊Õ...°..√..√..¡.. ...∑‘ ..∏..‘Ï....................................................

Õ“¬.ÿ ...Ù..ı..,...Û........ªï ‡™◊ÕÈ ™“μ‘............................... —≠™“μ.‘ ..........‰..∑..¬................∫‘¥“/¡“√¥“™◊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 .............................
¢//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 ‰ªπÈ’ :›
......................¢..Õâ....Ò.......∑...Ë’¥..‘π...·..ª...≈..ß..‡..§..√..◊ËÕ...ß..À..¡...“..¬..¢...â“..ß..∫..π...π..È’..¢..â“..æ...‡.®..â“..∑...ß—È .. ..Õ...ß..Ω..É“..¬...‰.¥...μâ ..°..≈...ß..°..π—...®..¥...∑..–..‡..∫..’¬...π.. ...∑‘ ..∏..‡‘..°..Á∫...°..π‘..‰..«..âμ..Õà...°..π—....μ...“..¡..∫...—π..∑...°÷ .......
.¢..âÕ..μ...°..≈...ß...≈...ß..«..π—..∑...’Ë.....................‡..¥..◊Õ...π.............................................æ....»...................................∫..¥—...π..’È..¢..“â..æ...‡.®..“â..∑...ß—È .. ..Õ...ß..Ω...“É .¬...‰.¥...μâ ..°...≈..ß..¬...π‘ ..¬...Õ..¡...„.À..â∑...¥Ë’...π‘ ..‡.©...æ..“..–... ..«à..π...∑..Ë·’..∫...ßà..·..¬...°..Õ...Õ..°...‰.ª...
.‡.ª..πì...‚.©...π..¥...„.À...¡..à‡..≈..¢..∑...’Ë .ı...ı......Õ...”..‡.¿...Õ..........................................................................ª..≈...Õ..¥...®..“..°.. ..∑‘...∏..‡‘..°..Á∫...°..‘π..‰..¥..â.......................................................................................
......................¢..âÕ....Ú.......¢...â“..æ..‡..®..â“..¬..Õ...¡..‡. ...’¬..§...“à ..∏..√..√..¡...‡.π...¬’ ..¡..„..À..μâ...“..¡..√..–...‡.∫...¬’ ..∫.........................................................................................................
......................∫...π— ..∑...°÷ ..¢..âÕ...μ..°...≈..ß..π...È∑’ ..”..‰..«..â .Ò....©...∫..—∫....‡..°..Á∫...‰.«..â..≥..... ..”..π..—°...ß..“..π..∑...¥Ë’ ..‘π....¢...â“..æ..‡..®..â“..∑..—Èß.. ...Õ..ß..Ω...É“..¬..‰..¥..μâ...√..«..®..∫...—π..∑...°÷ ..¢..âÕ...μ..°...≈..ß..·...≈..–..‡..¢..â“..„.®..¢...âÕ..§...«..“..¡.
.μ..≈..Õ...¥..·...≈..â«....®..ß÷..‰..¥..≈â...ß..≈..“..¬...¡..◊Õ...™..Ë◊Õ..À...√..◊Õ..æ...‘¡..æ...≈å...“..¬..¡..◊Õ...‰.«..â‡..ª..πì...À..≈...°— ..∞..“..π...μ..Õà...À..π...“â ..æ..¬...“..π..·..≈...–..‡.®...“â ..æ..π...°— ..ß..“..π...∑..’Ë¥...π‘ .........................................................

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

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μ—«Õ¬à“ßÀ¡“¬‡≈¢ ˆ

 “√∫≠— ®¥∑–‡∫’¬π

(√“¬°“√®¥∑–‡∫’¬π·ª≈߇¥‘¡ ‚©π¥∑’Ë Ò)

®¥∑–‡∫’¬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 𓬠°. μ“¡ —≠≠“ §ß‡À≈Õ◊ ‡≈¢∑Ë’¥‘π ≈ß≈“¬¡Õ◊ ™ÕË◊
‚©π¥∑’Ë¥π‘ „À¡à ª√–∑∫— μ√“
«—π∑.Ë’ ....................  ‘∑∏‡‘ °∫Á °‘π ‰√à ß“π μ“√“ß ‰√à ß“π μ“√“ß
‡¥◊Õπ................... «“ «“
æ.». .....................
𓬠¢. Û › › › › › › (≈ß™Ë◊Õ) 𓬠 .
º∑Ÿâ √ß ‘∑∏‡‘ °∫Á °π‘

«—π∑Ë.’ .................... ·∫àß·¬°„ππ“¡‡¥‘¡ 𓬠°. 𓬠°. Ò › › Ú › › 5136IV6000-9 (≈ß™ÕË◊ ).........................

‡¥◊Õπ................... (ª≈Õ¥›§√Õ∫ ∑‘ ∏‘ ∑¥’Ë π‘ ·ª≈ß∑’Ë·¬°‰ªπæ’È âπ®“° ‘∑∏‘‡°∫Á °π‘ ÛÛ

æ.»...................... ‡°∫Á °π‘ ) μ“¡∫—π∑°÷ ¢âÕμ°≈ߪ≈Õ¥ ‘∑∏‡‘ °Á∫°‘π ıı

©∫∫— ≈ß«π— ∑’Ë........‡¥◊Õπ...............æ.». ............

 à«π·ª≈ߧ߇À≈◊Õ ∑‘ ∏‡‘ °Á∫°π‘ ¬ß— §ß¡’Õ¬Ÿà

μ“¡∫—π∑°÷ ¢Õâ μ°≈ß ‘∑∏‘‡°∫Á °π‘

©∫—∫≈ß«π— ∑Ë’........‡¥◊Õπ...............æ.». ............

À¡“¬‡Àμÿ ∑¥Ë’ π‘ ·ª≈ß·¬°ª≈Õ¥ ‘∑∏‘‡°Á∫°‘π‰¡μà âÕ߬°√“¬°“√®¥·®âß·μÕà ¬à“ß„¥ ˜Û

˜Ù

μ—«Õ¬“à ßÀ¡“¬‡≈¢ ˜ (∑.¥. Ò)

∑∫Ë’ “â π

∑Ë’ «π/‰√à

∑’Ëπ“

∑.Ë’ .............

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

μ”·Àπàß∑Ë’¥‘π

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

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

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

‚©π¥∑¥’Ë π‘

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

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

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

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

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

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

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

ºâŸ....∂..Õ◊ ..°..√..√..¡... ..‘∑..∏...Ï‘ ..............

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

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

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

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

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

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

μ«— Õ¬à“ßÀ¡“¬‡≈¢ ˜ ˜ı

(∑.¥. Òˆ)

∫—π∑÷°¢Õâ μ°≈߇≈°‘  ‘∑∏‡‘ °∫Á °‘π

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

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

‡≈¢ª√–®”μ—«ª√–™“™π

¢“â 懮“â ..........π..“..¬....¢.......º..∑Ÿâ..√..ß.. ...‘∑..∏..‘‡..°..∫Á ..°..‘π...................................................
..........π..“..¬....°.......º..â∂Ÿ..◊Õ...°..√..√..¡.. ...∑‘ ..∏..‘Ï....................................................

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

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

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

¥//«â//¬//§//«/“/¡// //—μ//¬//®å /√//ß‘ / ¥ß— μÕà ‰ªπ’È :›
......................¢..Õâ....Ò.......¥...â«..¬..∑...’¥Ë ..‘π...·..ª...≈..ß..‡..§..√..ËÕ◊...ß..À..¡...“..¬..¥...ß— ..°..≈...à“..«..¢..â“..ß..∫...π..π...’È .¢...“â .æ...‡.®...â“..‡.ª...ìπ..º..Ÿâ∂...Õ◊ ..°...√..√..¡.. ...∑‘ ..∏...‘Ï .‰..¥..®â..¥...∑..–..‡..∫..¬’...π.. ...∑‘ ..∏..‘‡..°..Á∫...°..‘π...„.À...â .π...“.¬....¢.....
.‡.ª..ìπ...º..Ÿ∑â...√..ß.. ...‘∑..∏..‡‘..°..∫Á...°..‘π....μ...“.¡...∫...π— ..∑..÷°...¢..âÕ...μ..°...≈..ß....©..∫...∫— ..≈...ß..«..—π..∑...’.Ë ....................‡..¥..Õ◊...π..................................................æ.....»..............................................................................................
......................¢..Õâ....Ú.......∫...¥—..π...’È .π...“..¬....¢.....º...Ÿâ∑..√..ß... ..‘∑...∏..‘‡.°...Á∫..°..‘π....°...—∫....π..“..¬....°......‡.®..“â..¢...Õ..ß..∑...¥’Ë ..‘π...·..ª...≈..ß..π...’ȉ..¥..μâ...°..≈..ß...¬..π‘..¬...Õ..¡...‡.≈...°‘ .. ..‘∑...∏..‘‡..°..Á∫..°...‘π..√..“..¬...π..’·È...≈..â«........
μ...ßÈ—..·...μ..à«..—π...∑..Ë’......................‡.¥..Õ◊...π......................................................æ.....»...................................®..÷ß..¢..Õ...„.À...â‡.®..“â..æ...π..—°...ß..“..π..∑...¥Ë’ ..π‘...¥..”..‡..π..‘π...°..“..√..®..¥...∑..–..‡..∫..’¬...π..‡..≈..‘°.. ...∑‘ ..∏...‘‡.°..∫Á...°..‘π...μ..Õà...‰.ª........................
......................¢..âÕ....Û.......¢...â“..æ..‡..®..â“..¬..Õ...¡..‡. ...’¬..§...à“..∏..√..√..¡...‡.π...’¬..¡..μ...“..¡..√...–..‡.∫...’¬..∫.............................................................................................................
......................∫...—π..∑...÷°..¢..Õâ...μ..°...≈..ß..π...∑È’ ..”..‰..«..â .Ò....©...∫..∫—....‡..°..∫Á...‰.«..â..≥..... ..”..π..—°...ß..“..π..∑...’¥Ë ..π‘....¢...â“..æ..‡..®..â“..∑..ß—È.. ...Õ..ß..Ω...É“..¬..‰..¥..μâ...√..«..®..∫...—π..∑...÷°..¢..âÕ...μ..°...≈..ß..·...≈..–..‡..¢..“â ..„.®..¢...âÕ..§...«..“..¡.
μ...≈..Õ...¥..·...≈..«â....®..÷ß..≈...ß..≈..“..¬...¡..Õ◊...™..ËÕ◊ ..‰..«..‡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..âŸ∑...√..ß.. ...‘∑..∏..‘‡..°..Á∫...°..π‘ .........................
............................................................................................≈..ß...™..Ë◊Õ..................................π...“...¬.....°...............................º..â∂Ÿ...◊Õ..°...√..√..¡.. ...‘∑..∏...‘Ï ..........................
............................................................................................≈..ß...™..◊ËÕ...........................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..◊ËÕ............................................................................æ...¬..“..π...........................................
.............................∫...π— ..∑...°÷ ..¢..Õâ...μ..°...≈..ß..π...’ȉ..¥..∑â...”..μ..Õà...À..π...“â ......................................................................................................................................
............................................................................................≈..ß...™..Ë◊Õ............................................................................‡.®..“â..æ...π...°— ..ß..“..π..∑...¥’Ë..π‘..........................
..........................................................................................................ª..√..–..∑...∫—..μ...√..“..μ...”.·...À..π...ßà ..‡.ª...ìπ.. ...”..§..—≠..........................................................

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μ—«Õ¬à“ßÀ¡“¬‡≈¢ ˜ ˜ˆ

 “√∫—≠®¥∑–‡∫’¬π

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

μ«— Õ¬à“ßÀ¡“¬‡≈¢ ˜ ˜˜

(∑.¥. Ò)

∑∫’Ë “â π

∑’ Ë «π/‰√à

∑’Ëπ“

∑.’Ë .............

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

μ”·Àπàß∑’Ë¥‘π

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

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

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

‚©π¥∑Ë’¥‘π

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

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

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

Ú. ¢“â 懮â“..............π..“..¬....¢....(.μ...“.¬...)............... ‡≈¢ª√–®”μ—«ª√–™“™π ºŸ.â ..∑..√..ß.. ..∑‘...∏..‡‘.°...∫Á ..°..π‘..............

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

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

Õ¬∑àŸ 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

º.⟠...∂..Õ◊ ..°..√..√..¡... ..∑‘..∏...‘Ï ..............

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

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

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

(Ò) ¢“â 懮Ⓣ¡à‰¥â√—∫‚Õπ·∑πÀ√◊Õ‡æ◊ËÕª√–‚¬™πå·°∫à §ÿ §≈μ“à ߥ⓫
(Ú) √“§“∑√æ— ¬å∑’·Ë  ¥ß‰«â„π Ù. ‡ªìπ√“§“∑·Ë’ ∑â®√‘ß
(Û) .º..∑Ÿâ ..√..ß.. ...∑‘ ..∏..‡‘.°...Á∫..°..‘π...∂..÷ß..·..°..°à..√..√..¡...‡.¡..◊ÕË...«..π— ..∑..Ë.’.................‡.¥..◊Õ...π...................................................æ....»......................................μ..“..¡..À...≈..°— ..∞..“..π..¡...√..≥...∫..—μ...√...................

.≈..ß..«..π— ..∑...Ë’ ...............‡..¥..◊Õ..π.........................................æ...»...........................................................................................................
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«π— ∑.’Ë ...........‡¥Õ◊ π..............................æ.»..................
≈ß™◊ÕË ........................›..............................ºŸâ¢Õ ∑√ß ∑‘ ∏‡‘ °∫Á °π‘
≈ß™◊ËÕ....................π..“..¬....°...........................ºŸâ¢Õ ∂◊Õ°√√¡ ‘∑∏‘Ï
≈ß™◊ËÕ......................................................º Ÿâ Õ∫ «π

(......................................................)
 ”À√∫— æπ—°ß“π‡®“â Àπ“â ∑Ë’
Ò) √“§“ª√–‡¡‘π∑ÿπ∑√—æ¬å.....................................................................................................∫“∑........................................ μ“ߧå
Ú) ‚©π¥∑Ë¥’ ‘π„À¡à√–«“ß............................................‡≈¢∑¥Ë’ ‘π...............................................Àπ“â  ”√«®.........................................
‚©π¥∑¥’Ë π‘ ‡≈¢∑’.Ë ..................................................‡≈¡à ......................................................Àπ“â ..................................................
®”π«π∑¥’Ë π‘ ......................................................‰√.à ................................................ß“π..................................................μ“√“ß«“
§ß‡À≈Õ◊ ...........................................................‰√.à ................................................ß“π..................................................μ“√“ß«“
Û) ‰¥®â ¥∑–‡∫’¬π·≈«â ·μà«—π∑.Ë’ ................................‡¥◊Õπ............................................æ.»......................

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

˜¯

μ«— Õ¬“à ßÀ¡“¬‡≈¢ ¯

(∑.¥. Òˆ)

∫—π∑÷°∂Õâ ¬§”‡≈‘° ‘∑∏‘‡°∫Á °π‘

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

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

‡≈¢ª√–®”μ—«ª√–™“™π

¢“â 懮“â ..............π...“..¬...°............................................................................

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

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 .............................
¢ÕªØ≠‘ “≥μπ·≈–„À∂â Õâ ¬§”μÕà ......‡.®..“â..æ..π...°— ..ß..“..π..∑..¥’Ë...π‘ ........................................................................................................................

¥â«¬§«“¡ —μ¬å®√ß‘ ¥—ßμàÕ‰ªπÈ’ :›
......................¢..Õâ....Ò.......¥...â«..¬..∑...Ë’¥..‘π...·..ª...≈..ß..‡..§..√..Õ◊Ë...ß..À..¡...“..¬..¥...ß— ..°..≈...à“..«..¢..â“..ß..∫...π..π...È’ .¢...â“.æ...‡.®...“â ..‡.ª...ìπ..º..∂Ÿâ...◊Õ..°...√..√..¡.. ...∑‘ ..∏...Ï‘ .‰..¥..â®..¥...∑..–..‡..∫..’¬...π.. ...∑‘ ..∏..‡‘..°..∫Á...°..π‘...„.À...â .π...“.¬....¢.....
.‡.ª..ìπ...º..âŸ∑...√..ß.. ...‘∑..∏..‡‘..°..Á∫...°..π‘....μ...“.¡...∫..π—...∑..÷°...¢..Õâ...μ..°..≈...ß....©..∫...—∫..≈...ß..«..—π..∑...Ë.’ ....................‡..¥..◊Õ...π......................................................æ....».............................................................................................
......................¢..Õâ....Ú.......∫...¥—..π...È’ .π...“..¬....¢.....º...Ÿ∑â ..√..ß... ..‘∑...∏..‡‘ .°...Á∫..°..π‘...‰.¥...â∂..÷ß..·...°..°à...√..√..¡....‡.¡...Õ◊Ë ..«..π—...∑..’Ë......................‡.¥..◊Õ...π...................................................æ....»...................................ª...√..“..°..Ø...μ..“..¡............
 ...”..‡.π...“..¡..√..≥....∫..—μ...√..∑..’¬Ë...◊πË ..¡...“..ª..√..–...°..Õ..∫...°..“..√..æ...®‘..“..√..≥....“..æ..√..âÕ...¡..°...∫— ..∫...π— ..∑...÷°..∂...âÕ..¬..§...”..π..’¥È...«â ..¬..·...≈..â«....®..ß÷..¢..Õ...„.À...â‡.®..“â..æ...π..°—...ß..“..π..∑...¥Ë’ ..‘π...¥..”..‡..π..π‘...°..“..√..®..¥...∑..–..‡..∫..’¬...π.........
.‡.≈..°‘... ..‘∑...∏..‘‡.°...Á∫..°...π‘ ..μ...àÕ..‰.ª..................................................................................................................................................................................
......................¢..Õâ....Û.......¢...â“..æ..‡..®..“â ..¬..Õ...¡..‡. ...’¬..§...à“..∏..√..√..¡...‡.π...¬’ ..¡..μ...“..¡..√...–..‡.∫...’¬..∫.............................................................................................................
......................¢..â“..æ...‡.®...“â .‰..¥..μâ...√..«..®..·...≈..–..Õ...“à ..π..¢..âÕ...§..«...“.¡...¥..ß—...°..≈..à“..«..·...≈..â«....∂..°Ÿ...μ..âÕ...ß...®..ß÷...≈..ß..≈...“..¬..¡...Õ◊ ..™..ËÕ◊...‰.«..‡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..âŸ.„.À...â∂..âÕ..¬...§..”..................................
............................................................................................≈..ß...™..◊ËÕ...........................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..Ë◊Õ............................................................................æ...¬..“..π...........................................
............................................................................................≈..ß...™..◊ËÕ............................................................................‡.®..“â..æ...π...°— ..ß..“..π..∑...¥’Ë..π‘..........................

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μ«— Õ¬à“ßÀ¡“¬‡≈¢ ¯

 “√∫—≠®¥∑–‡∫’¬π

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

˜˘

¯

μ«— Õ¬“à ßÀ¡“¬‡≈¢ ˘ (∑.¥. Ò)

∑∫Ë’ “â π

∑Ë’ «π/‰√à

∑’Ëπ“

∑Ë.’ .............

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

μ”·Àπàß∑’Ë¥‘π (À√◊Õμ≈Õ¥™’«‘μ¢ÕߺŸ∑â √ß ∑‘ ∏‘‡°Á∫°‘π)

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

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

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

‚©π¥∑’Ë¥‘π

 ‘∑∏‘‡ Á°∫°‘π√“¬πÈ’ 𓬠°. ¡’ ‘ ∑∏‘∫Õ°‡≈‘° ‘∑∏‘‡ Á°∫°‘π®“° 𓬠¢. ‡¡◊ËÕ„¥°Á‰ ⥠‡≈¢∑.’Ë ...........................................‡≈¡à ........................................Àπ“â ....................................
‡®â“æπ—°ß“π Ë’∑¥‘π ®”π«π∑¥Ë’ ‘π...............Ò....................‰√.à ................›................ß“π..................›.................μ“√“ß«“

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

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

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

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

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

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

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

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

(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) .....................................................................................................................................................................
(Ù) .....................................................................................................................................................................
(ı) .....................................................................................................................................................................

«π— ∑.Ë’ ...........‡¥Õ◊ π..............................æ.»..................
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≈ß™Õ◊Ë .....................π..“..¬...¢..........................ºŸâ¢Õ ∑√ß ∑‘ ∏‡‘ °∫Á °π‘
≈ß™Ë◊Õ......................................................º âŸ Õ∫ «π

(......................................................)
 ”À√∫— æπ°— ß“π‡®â“Àπâ“∑Ë’
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®”π«π∑¥’Ë π‘ ......................................................‰√.à ................................................ß“π..................................................μ“√“ß«“
§ß‡À≈Õ◊ ...........................................................‰√.à ................................................ß“π..................................................μ“√“ß«“
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≈ß™◊ËÕ.......................................................
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μ«— Õ¬à“ßÀ¡“¬‡≈¢ ˘ ¯Ò

(∑.¥. Òˆ)

∫—π∑÷°¢Õâ μ°≈ß ‘∑∏‘‡°∫Á °π‘

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

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

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

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

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

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

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............................................................................................≈..ß...™..Ë◊Õ....................................................................................................................................æ...¬..“..π...........................................
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.............................∫...—π..∑...÷°..¢..âÕ...μ..°...≈..ß..π...È’‰..¥..∑â...”..μ..Õà...À..π...“â ......................................................................................................................................
............................................................................................≈..ß...™..Ë◊Õ.....................................................................................................................................‡.®..“â..æ...π...°— ..ß..“..π..∑...¥Ë’..π‘..........................
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¯Ú

μ—«Õ¬à“ßÀ¡“¬‡≈¢ ˘

 “√∫—≠®¥∑–‡∫¬’ π

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

«—π∑Ë.’ ....................  ‘∑∏‡‘ °∫Á °π‘ 𓬠°. 𓬠¢. Ò › › › › › › (≈ß™Ë◊Õ).........................
º∑⟠√ß ‘∑∏‘‡°Á∫°π‘  ∑‘ ∏‡‘ °Á∫°π‘ √“¬πÈ’ 𓬠°. ¡’ ‘∑∏‘∫Õ°‡≈°‘
‡¥Õ◊ π................... (¡°’ ”Àπ¥.............ªï)
 ‘∑∏‘‡°Á∫°π‘ ®“° 𓬠¢. ‡¡Õ◊Ë „¥°Á‰¥â
æ.»...................... (À√◊Õμ≈Õ¥™’«‘μ¢Õß

ºŸâ∑√ß ∑‘ ∏‘‡°Á∫°‘π)

¯Û

√–‡∫¬’ ∫°√¡∑’¥Ë ‘π

«“à ¥«â ¬°“√®¥∑–‡∫¬’ π ‘∑∏·‘ ≈–π‘μ‘°√√¡‡°Ë¬’ «°—∫¿“√–®”¬Õ¡„π∑Ë¥’ π‘
·≈–Õ ß— À“√‘¡∑√æ— ¬Õå ¬“à ßÕπË◊
æ.». Úıı

‚¥¬∑’ˇÀÁπ‡ªìπ°“√ ¡§«√„Àâ¡’°“√√«∫√«¡·≈–ª√—∫ª√ÿßÀ≈—°‡°≥±å

·≈–«‘∏’°“√®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡‡°Ë’¬«°—∫¿“√–®”¬Õ¡„π∑Ë’¥‘π·≈–

Õ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ ‡æË◊Õ„Àâæπ—°ß“π‡®â“Àπâ“∑’Ë “¡“√∂ªØ‘∫—μ‘ß“π¥â«¬§«“¡

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μ≈Õ¥®π‡ªìπ¡“μ√∞“π‡¥¬’ «°π—

Õ“»—¬Õ”π“®μ“¡§«“¡„π¡“μ√“ ÛÚ ·Ààßæ√–√“™∫—≠≠—μ‘√–‡∫’¬∫

∫√‘À“√√“™°“√·ºàπ¥‘π æ.».ÚıÛÙ ´Ë÷ß·°â‰¢‡æ‘Ë¡‡μ‘¡‚¥¬æ√–√“™∫—≠≠—μ‘

√–‡∫¬’ ∫∫√‘À“√√“™°“√·ºπà ¥‘π (©∫—∫∑’Ë ı) æ.».ÚıÙı ª√–°Õ∫°—∫¢âÕ Ú (Ò)

(Ù) ·≈– ¢Õâ Ù °. (Òı) (°) ·Àßà °Æ°√–∑√«ß·∫ßà  «à π√“™°“√°√¡∑¥’Ë π‘ °√–∑√«ß

¡À“¥‰∑¬ æ.».ÚıÙı ÕÕ°μ“¡§«“¡„πæ√–√“™∫≠— ≠—μ√‘ –‡∫¬’ ∫∫√‘À“√√“™°“√

·ºπà ¥π‘ æ.».ÚıÛÙ Õ∏‘∫¥°’ √¡∑Ë¥’ π‘ ®÷ß«“ß√–‡∫¬’ ∫‰«¥â ß— μàÕ‰ªπ’È

¢âÕ Ò √–‡∫’¬∫π’ȇ√’¬°«à“ ç√–‡∫’¬∫°√¡∑Ë’¥‘π «à“¥â«¬°“√®¥∑–‡∫’¬π ™Ë◊Õ√–‡∫’¬∫

 ‘∑∏‘·≈–π‘μ‘°√√¡‡°Ë’¬«°—∫¿“√–®”¬Õ¡„π∑Ë’¥‘π·≈–Õ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ

æ.».Úııé

¢âÕ Ú √–‡∫’¬∫π’È„Àâ„™â∫—ߧ∫— μÈ—ß·μà∫¥— πÈ’‡ªìπμâπ‰ª °“√∫—ߧ—∫„™â

¢Õâ Û „À⬰‡≈°‘ √–‡∫¬’ ∫ §” Ëß— ∑’¬Ë °‡≈°‘

(Ò) §” Ë—ß°√¡∑¥Ë’ ‘π ∑Ë’ ˜/ÚıÙ ≈ß«—π∑Ë’ Ú˘ ¡∂‘ πÿ “¬π ÚıÙ

(Ú) Àπ—ß ◊Õ°√¡∑’¥Ë π‘ ∑’Ë ¡∑ ˆ¯/« Òı˘Òı ≈ß«π— ∑’Ë Ò˘ 情¿“§¡

ÚıÒÙ

(Û) Àπ—ß Õ◊ °√¡∑¥Ë’ ‘π ∑’Ë ¡∑ ˆÒÚ/Ò/« Òˆˆ¯Ò ≈ß«—π∑’Ë ˆ  ‘ßÀ“§¡

ÚıÚÛ

(Ù) Àπß—  Õ◊ °√¡∑¥’Ë ‘π ∑Ë’ ¡∑ ˆÒÚ/Ò/« Úı¯Ûˆ ≈ß«—π∑Ë’ ÒÒ ∏—𫓧¡

ÚıÚÛ

¯Ù

°√≥¡’ ’¢âÕ¢¥— ·¬ßâ °—π ∫√√¥“√–‡∫¬’ ∫ ¢Õâ °”Àπ¥ À√Õ◊ §” ß—Ë ÕπË◊ „¥∑°Ë’ ”À𥉫·â ≈«â „π√–‡∫¬’ ∫πÈ’

À√Õ◊ ´÷Ëߢ¥— À√◊Õ·¬âß°∫— √–‡∫’¬∫π’È„Àâ„™â√–‡∫¬’ ∫π’·È ∑π

ºâŸ√°— …“°“√√–‡∫’¬∫ ¢Õâ Ù „Àºâ Õ⟠”𫬰“√ ”π°— ¡“μ√∞“π°“√∑–‡∫¬’ π∑¥’Ë π‘ ‡ªπì º√Ÿâ °— …“°“√

μ“¡√–‡∫’¬∫πÈ’

À¡«¥ Ò

°“√¬πË◊ §”¢Õ °“√ Õ∫ «π ·≈–ª√–‡¿∑°“√®¥∑–‡∫’¬π

°“√¬π◊Ë §”¢Õ ¢âÕ ı ‡¡◊ËÕ¡’ºŸâ· ¥ß§«“¡ª√– ß§å¢Õ®¥∑–‡∫’¬π ‘∑∏‘·≈–π‘μ‘°√√¡

‡°Ë’¬«°—∫°“√®¥∑–‡∫’¬π¿“√–®”¬Õ¡„π∑’Ë¥‘π·≈–Õ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ ´Ë÷ß

‡¡Ë◊Õ°àÕ„À⇰‘¥¿“√–®”¬Õ¡„πÕ —ßÀ“√‘¡∑√—æ¬å„¥®–‡ªìπ‡Àμÿ„À⇮ⓢÕß

Õ —ßÀ“√‘¡∑√—æ¬åπÈ—πμâÕ߬ա√—∫°√√¡∫“ßÕ¬à“ß´÷Ëß°√–∑∫°√–‡∑◊Õπ∂÷ß°“√„™â

 ‘∑∏‘„π∑√—æ¬å ‘π¢Õßμπ À√◊ÕμâÕßߥ‡«âπ°“√„™â ‘∑∏‘∫“ßÕ¬à“ßÕ—π¡’Õ¬àŸ„π

°√√¡ ‘∑∏‘Ï∑√—æ¬å ‘ππÈ—π‡æ◊ËÕª√–‚¬™πå·°àÕ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ μ“¡¡“μ√“

ÒÛ¯˜ ·Ààߪ√–¡«≈°ÆÀ¡“¬·æàß·≈–æ“≥‘™¬å „Àâ∫ÿ§§≈π—Èπ¬Ë◊π§”¢Õμ“¡·∫∫

∑.¥.Ò  ”À√—∫∑Ë’¥‘π∑’Ë¡’‚©π¥∑Ë’¥‘π À√◊Õ·∫∫ ∑.¥.Ò °  ”À√—∫∑’Ë¥‘π∑’ˬ—߉¡à¡’

‚©π¥∑’Ë¥‘π·≈–Õ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕË◊πμàÕæπ—°ß“π‡®â“Àπâ“∑Ë’æ√âÕ¡Àπ—ß ◊Õ

· ¥ß ‘∑∏‘„π∑’Ë¥‘πÀ√◊ÕÀ≈—°∞“π ”À√—∫Õ —ßÀ“√‘¡∑√—æ¬åÕ¬à“ßÕ◊Ëπ·≈–À≈—°∞“π∑’Ë

‡°Ë¬’ «¢âÕß

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μ“¡∫π— ∑°÷ ¢Õâ μ°≈ߥ—ß°≈à“«§√Õ∫μ‘¥Õ¬éŸà (μ“¡μ«— Õ¬“à ßÀ¡“¬‡≈¢ ˘)

°√≥’·∫ßà ·¬°·ª≈ß ¢âÕ Ò¯ °√≥’∑Ë’¡’°“√¢Õ®¥∑–‡∫’¬π·∫àß·¬°∑Ë’¥‘π·ª≈ß “¡¬∑√—æ¬å

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¿“√–®”¬Õ¡Õ’° (μ“¡μ«— Õ¬à“ßÀ¡“¬‡≈¢ ÒÒ)

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(𓬙—¬ƒ°…å ¥‘…∞Õ”π“®)
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(ª√–°“»√“™°‘®®“π‡ÿ ∫°…“ ‡≈¡à ÒÚÙ μÕπ懑 »… ˘ı ß ≈ß«—π∑Ë’ Ò‹  ‘ßÀ“§¡
Úıı)

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μ—«Õ¬à“ßÀ¡“¬‡≈¢ Ò (∑.¥. Ò)

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(‚©π¥∑’‡Ë ªπì ·ª≈ß¿“√¬∑√—æ¬)å ∑ Ë’ «π/‰√à
∑’Ëπ“

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μ”·Àπàß∑’Ë¥‘π

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

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

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

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

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(Ù) .....................................................................................................................................................................
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μ—«Õ¬à“ßÀ¡“¬‡≈¢ Ò ˘ı
(‚©π¥∑Ë’‡ªìπ·ª≈ß¿“√¬∑√æ— ¬å)
(∑.¥. Òˆ)

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

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μ«— Õ¬à“ßÀ¡“¬‡≈¢ Ò ˘ˆ

 “√∫—≠®¥∑–‡∫¬’ π

(‚©π¥∑‡Ë’ ªπì ·ª≈ß¿“√¬∑√æ— ¬å)

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