General Document Request Form

General Document Request Form
Student ID*
[62XXXXX]
Name*

First NameLast Name
Program*
Plan*
Department*
Mobile No.*
Email*
Language*

EnglishThai
Certification Requested*

Student's statusWorking on Thesis/Thematic paperOther
Purpose
No. of copy (ies)*
Total quantity
Amount (THB)*
Payment method*

Cash (at BSTM office)Mobile Banking/Internet banking
Accountant name: นางสาวสมพร งามศิริสมสกุล และ/หรือ นางอารี บัวแพร และ/หรือ นางสาววนัชพร ทองปาน

Account number: 254-222953-6

Bank name: Siam Commercial Bank PCL. (SCB)

Branch: Hospital for Tropical Diseases
e-slip upload*

Cancelof
Notification:
- Receipt of original documents is only available at the office; there is no postal delivery service due to the importance of the governmental documents.
- The document will take 5 working days to process. If the process is completed successfully, the officer will notify via email.
Should be Empty: