APPLICATION FOR 'ISSUANCE OF NEW CHEQUE IN REPLACEMENT OF LOST CHEQUE'
Written at..........................................
Date...................................................
Dear Registrar of.........................................................................................................
I................................................................................as a shareholder of the mentioned company / bank have
lost the substituted payment for dividend / dividend / interest cheque, Number.............................................................
dated..................................... in the amount of baht ............................. and have reported of such incident to the police
officer at ...................... police station (evidence attached). Herein, I request the Thailand Securities Depository
Co.,Ltd.to issue a new cheque to me and
( ) issue a new draft in foreign currency (please specify only one currency)
... ...
(The process to issue a new draft in foreign currency approximately spends 15 business working days.)
( ) send the new cheque to...............................................................................................................................
..............................................................................................................................................by registered mail.
( ) contact me at tel :......................................................................so that I can collect the cheque in person.
Upon the request in this application, I solemnly promise that if I find the old cheque, I shall return it
immediately to the Thailand Securities Depository Co., Ltd.
Upon issuance of new cheque by the Thailand Securities depository Co., Ltd. according to my motion
this time, if there incur any damages, obligations and expenses under any condition to the Thailand Securities
Depository Co.,Ltd., I shall be reponsible for and shall compensate in full to the Thailand Securities Depository
Co., Ltd.
Signature..........................................................................Shareholder
Required documents (Please see next page)
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For officer of Thailand Securities Depository Co., Ltd.
I have received this application for proceedings on (date)
Signature................................................................Authorised officer
For shareholder collecting the cheque
I have received the new cheque, Number......................................................on (date).......................................
Signature.........................................................................Shareholder
Police report mentioning the details of the cheque and Other Documents to be submitted along with
this document under various conditions
(All photocopies must be certified as true)
Natural Person
1. Copy of the security owner0s identification card or
2. Copy of other cards, house registration certificate (which appears the name and identification
number of the security owner) or
3. Copy of alien certificate or passport (For other nationality)
Juristic Person
1. Copy of Affidavit issued by Ministry of Commerce not exceeding 1 year and
2. Copy of the identification card of the director empowered as signatory.
Minor
1. Minor of 15 years of age can proceed with the corrections and must attach a certified copy of his/her
identification card.
2. Minor of less than 15 years of age must assign his/her parent (Mother/Father) or legal guardian as
signatory and accordingly attach the following documents:
2.1 Copy of birth certificate or house registration certificate which appears the name of the minor.
2.2 Copy of the identification cards of Father/Mother or legal guardian of the minor.
* In case where either a father or mother signs the document, an evidence stating single parental
power must be submitted.
* In case where the guardian is not the father or mother of the minor, an evidence stating legal
guardianship must be submitted.
In case of the authorization
1. The power of Attorney (Stamp Duty 10 Bahts)
2. Copy of the Indentification Card of the appointcc