Representative Email (If applicable)

Client Surname

Client Name

Client's Address on Google

If the address cannot be found on Google, please write it down here

Client's Postcode

Region

Region 1: Pattaya, Si Racha, Chonburi, Rayong, Chanthaburi, TratRegion 2: Bangkok, Ratchaburi, Chachoengsao, Pathum Thani, Ayutthaya, Nakhon Pathom, SaraburiRegion 3. Chiang Mai, Chiang Mai, Nan, Mae Hong Son, Lampang, UttaraditRegion 4: Phuket, Krabi, Phang Nga, Samui, Trang, Krabi, Surat ThaniRegion 5: Khon Kaen, Buriram, Surin, Mukdahan, Nakhon Ratchasima, AranyaprathetRegion 6: Udon Thani, Sakon Nakhom, Nakhon Phanom, Nong Khai, Bueng Kan, LoeiNot Applicable

Does your passport have at least one year remaining before expiring?

YesNo

Passport Front Page Image (Your photo and information pages)

Do you have a retirement visa already?

YesNo

Current visa stamp image (If applicable)

Do you have a Bangkok Bank account?

YesNo

Do you have the required 800,000THB in a Thai bank for at least four months? (any Thai bank is OK)

YesNo

800,000THB in Bank Evidence (Bank book photo of the deposited amount)

Bank Book Information Page Image (This is the page with account and name information)

Do you have the bank letter with deposit information?

YesNo

Bank Confirmation Letter Image (If applicable)

Do you have a visa exempt stamp (issued on arrival)?

YesNo

Visa Exempt Stamp (If applicable)

Do you live in Pattaya?

YesNo

Do you have medical insurance and a copy of the insurance certificate?

YesNo

Medical Insurance Certificate (If applicable)

Do you have a total of ten passport photos?

YesNo

Do you have a residency confirmation letter from the condo/ resort manager or a house blue book?

YesNo

Condo Letter/ Blue Book evidence (If applicable)

Do you have a Certificate of Residency? (required for those without a Thai bank book)

YesNo

Certificate of Residency image (If applicable)

Do you have more than twenty days remaining on your current visa?

YesNo

Do you have your TM.6 departure card?

YesNo

TM.6 Photo (If applicable)

Please provide a photo of yourself from bottom of your chest to two centimetres above your head. This sent to Immigration to verify we are talking to the passport holder. if you cannot provide one right now, skip this section.

StayLeave

Please note any particulars you would like to mention or special considerations you would like to put forward with your request.