Page 70 - MK01-96
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                         FORM FOR ALIEN TO NOTIFY OF STAYING LONGER THAN 90 DAYS
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                                                                   Á…¥œš ¦·¬´š ˜´ª°¥nµŠÃž¦Â„¦¤ °¸-·Ž·Áœ­ ¡¨´­ ‹Îµ„´
                                                                       ¸  /8/5   5/1.6 B /A // 19- 8 8@ .  /5.  7 5
                                                                   WRITTEN AT
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                                                                ª´œš 01/12/2563
                                                                DATE
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                  Á¦¥œ    ¡œ´„еœÁ‹oµ®œoµš˜¦ª‹‡œÁ…oµÁ¤°Š
                  TO :  THE IMMIGRATION OFFICER
                         —oª¥…oµ¡Á‹oµ Ms.Michael Evans
                                                 (FULL NAME IN BLOCK LETTERS)
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                  ­´µ˜ °´Š„§¬                 ž¦³Á£šªŽnµ               /  TOURIST
                  NATIONALITY                   VISA                       NON-IMM.
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                  Á—œšµŠÁ…oµ¤µÁ¤°ª´œš 01/09/2563
                  ENTERED THAILAND ON                                   BY
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                  ®œ´Š­°Á—œšµŠÁ¨…š A123456                   ˜µ¤´˜¦…µÁ…oµÁ¨…š 0000000001
                  PASSPORT NO.                               ARRIVAL CARD NO.
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                         ´—œÊ ŗo°¥nĜ¦µ°µ–µ‹´„¦Å𥇦 ÚÑ ª´œÂ¨oª ¨³¡Îµœ´„°¥nš 133
                         I HAVE NOW BEEN STAYING IN THAILAND FOR 90 DAYS AND MY PRESENT ADDRESS IS
                  ް¥/™œœ ­°Š¡¸Éœo°Š            ˜Îµ¨ Á­µ›Š®·œ             °ÎµÁ£° µŠÄ®n
                  LAND/ROAD                     TAMBOL                     AMPHUR
                  ‹´Š®ª´— œœš»¦¸                  Ú¦«´¡šr 02-589-1121
                  PROVINCE                         PHONE
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                  NOTICE :  ALIEN MUST NOTIFY THE IMMIGRATION OFFICE EVERY 90 DAYS
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                                        ĝ¦Â‹Š„µ¦°¥¼Á„·œ ÚÑ ª´œ  …°Š»‡‡¨˜µŠ—µª
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                                             RECEIPT OF NOTIFICATION
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                                               FOR OFFICIAL USE ONLY
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                  ŗo¦Â‹oŠ„µ¦°¥nĜ¦µ°µ–µ‹´„¦Å𥠇¦ ÚÑ ª´œ …°Š  Ms.Michael Evans
                  HAVE RECEIVED NOTIFICATION OF STAYING IN THAILAND FOR 90 DAYS FROM
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                  ­´µ˜ °´Š„§¬        Ūo¨oª Á¤°ª´œš É ¸         Á—°œ             ¡.«.
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                  NATIONALITY           ON    DATE                 MOUNTH           YEAR
                  Áª¨µ                  œ.
                  HOUR
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                                                                SIGNATURE           IMMIGRATION OFFICER
              //  /-  N .  /.  ?   ?                                                                               70
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