Request for Letter of Reference (LOR) Form

Date
To United Overseas Bank (Thai) Public Company Limited

I, Mr. Mrs. Miss Other (Please specify) ANCTEK (THAILAND) CO., LTD.
First Name Last Name
Account Number(s) 7509000275
would like to request United Overseas Bank (Thai) Public Company Limited to issue a Letter of Reference on my behalf to be presented to
(name of addressee) BOI with 1 copy(ies) in Thai English as per requirements below:
1) Letter of Reference is to be issued on (please select one only) Specify Currency
Account holder’s name
As a guarantor of Mr. Mrs. Miss Other (Please specify)
First Name Last Name
2) Disclosure of account information
Confirm balance Confirm balance digit Confirm deposit with the Bank
Confirm OD facility Confirm OD facility digit
× Confirm transfer of fund Confirm transfer of fund for the Department of Lands
Amount 6000000@33.47 Baht Date of transfer 2025/03/14 Transfer from NBDC SINGAPORE PTE. LTD
Purpose of transfer Capital injection
Confirm bail amount and allow the Bank to seize the balance of THB
Account statement date from to
Other (Please specify)
Payment by Cash Baht Debit A/C 200 Baht Current/Saving Account 7509000275 Branch Rayong branch
(Waive fee for customer PVB WB)
I/We hereby authorize the Bank to disclose the information listed in the account(s) as shown above in the Letter of Reference. Any reliance
I place on such information is entirely at my own risk. The Bank shall not be liable for any use, misconduct, loss, or damage resulted from and/or
relating to the information disclosed.

Authorized Signature
( )

Collection of Letter of Reference Collect personally at Branch For bank use only
Name (s), account number (s), and signature(s) verified and approved for processing

I have collected the Letter of Reference Attended By

( )
Collector
( ) Approved By
Date ( )

Documentations Request Authorization Code

1. Copy of ID Card / Passport / Registration Certificate
2. Receipt
3. Alert Info screen
 Power of Attorney
For Individual
I , First Name Last Name
Address
ID card number/Passport number Issue at
Date of Issued Date of Expiry Reachable Contact Number
Hereby authorize and appoint (First name) (Last name)
(“the Authorization Representative”)
Address
ID card number/Passport number Issue at
Date of Issued Date of Expiry Reachable Contact Number
to be my representative to request the letter of reference from the United Overseas Bank (Thai) Public Company Limited (“the Bank”) on my behalf
and to allow the Bank to deduct the fee for issuance of the letter of reference from my bank account and to perform any act to satisfy the previously
mentioned purpose on my behalf. Any act performed by the Authorization Representative within the scope of this Power of Attorney shall be legally
bound by me.

Signed Grantor of Authorization Signed Authorization Representative

( ) ( )

For Juristic
Business name
Address
Authorize director name
ID card number/Passport number
Authorize director name
ID card number/Passport number
Authorize director name
ID card number/Passport number
Refer to the company registration certificated number
Here by authorize and appoint (First name) (Last name)
ID card number/Passport number Issue at
Date of Issued Date of Expiry Reachable Contact Number
to be my representative to request the letter of reference from United Overseas Bank (Thai) Public Company Limited (“the Bank”) on my behalf and
to allow the Bank to deduct the fee for issuance of the letter of reference from my bank account and to perform any act to satisfy the previously
mentioned purpose on my behalf. Any act performed by the Authorization Representative within the scope of this Power of Attorney shall be legally
bound by me.

Signed Grantor of Authorization Signed Grantor of Authorization

( ) ( )

Signed Grantor of Authorization Signed Authorization Representative

( ) ( )

RBGF_014-20220429-V2E 2/2 RBGF_014-20150615-V1E