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Please attach 1 photograph taken within

the last 6 months. (3.5 x 4.5 cm)

APPLICATION

FOR QUALIFICATION ENDORSEMENT

FOR SMART VISA “S”

1. Applicant’s Personal Data

Mr. Mrs. Ms. First Name Middle Name Family Name

Nationality Country of Birth

Date of Birth (D/M/Y) Age

Passport No. Issued at

City Country

Date of Issue Date of Expiry

Marital Status SINGLE MARRIED DIVORCED WIDOWED SEPERATED

Name of Spouse (if any)

Nationality Date of Birth (D/M/Y) Age

Name of Children (if any)

(1) Name Nationality

Date of Birth (D/M/Y) Age

(2) Name Nationality

Date of Birth (D/M/Y) Age

(3) Name Nationality

Date of Birth (D/M/Y) Age

(4) Name Nationality

Date of Birth (D/M/Y) Age

Current address of Applicant

City Province/State

Country Postal Code

Tel. E-mail

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Educational Background

Year of

graduation

Full name of Educational

Institution

City Country Department / Major

Educational

Level

Note: Supplementary sheets may be attached if additional space is required.

Work Experience

Starting

Year

Ending

Year

Full name of

company or

organization

City Country Job Position Responsibilities

Note: Supplementary sheets may be attached if additional space is required.

Note: Supplementary sheets may be attached if additional space is required.

Awards (if any)

Date of award

(DD/MM/YY)

Award Project Awarding

Agency Country

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Please provide copies of these certificates.

2. Type of Participation in Thailand

☐ 2.1) I am participating in an incubation, accelerator or similar program endorsed by a government

agency

2.1.1) Incubator/accelerator/similar program in which you participate in

Name

Address

Sub-district District

Province Postal Code

Tel. E-mail

Contact Person at the program in which you participate

Mr. Mrs. Ms. First Name Middle Name Family Name

Tel ________________________________Mobile

Email______________________

Certificate of Professional Qualifications / Certification of related area of expertise (if any)

Certificate date

(DD/MM/YY)

Certificate name Issuing Agency Country

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2.1.2) Endorsing Agencies

Name and Address of the government agency which endorses the program in which you participate

Name

Address

Sub-district District

Province Postal Code

Tel. E-mail

☐ 2.2) I have received or will receive joint venture funding from a Thai government agency (such as

DEPA) (Please specify the program.)

2.2.1) Details of project

(Please attach supplementary details i.e. project description/project proposal which includes products,

technical process, core technology, target market etc.)

2.2.2) Ownership or position of the applicant within the company

Please provide the Information where applicable (more than one choice can be selected)

☐ I hold/will hold the company’s shares about Baht which accounts for % of the

company’s total shares.

☐ I am/will be a director of the company or other position (please specify)

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3. Details of Your Activities in Thailand

Startup Name

Slogan (If any)

Please choose the startup sectors/ targeted industries /startup stage most relevant to your activities.

Startup Sectors Targeted Industries Startup Stage

☐ HealthTech ☐ Next-Generation Automotive ☐ Idea

☐ TravelTech ☐ Smart Electronics ☐ Prototype

☐ FinTech ☐ Affluent, Medical and Wellness Tourism ☐ Launched

☐ Business/ ServicesTech ☐ Agriculture and Biotechnology ☐ Scale up

☐ IndustryTech ☐ Food for the Future

☐ PropertyTech/ UrbanTech ☐ Automation and Robotics

☐ GovTech/ EdTech ☐ Aviation and Logistics

☐ LifestyleTech ☐ Biofuels and Biochemicals

☐ AgTech/ FoodTech ☐ Digital

☐ Other (please specify) .

☐ Medical Hub

General Details

Summary description of your products or services

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Business Model

Description of the idea and business model

Mission

Description of your organization’s mission

Vision

Description of your organization’s vision

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Target market

Description of your target customers or clients

Growth Strategy

Please explain your growth objectives and how you intend to develop your startup business

Note: Supplementary sheets may be attached if additional space is required.

Why is your startup innovative? Please explain

Note: Supplementary sheets may be attached if additional space is required.

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Key persons in your organization/team

Title Name

Total number of team members

Please specify your funding sources. A list of your funding sources that you already have or your potential financial sources

1.

2.

3.

4

5.

Why did you choose Thailand as your destination? Please explain

Note: Supplementary sheets may be attached if additional space is required.

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Please explain how your business would benefit Thailand? Please explain

Note: Supplementary sheets may be attached if additional space is required.

Describe your plan for investment and setting up a company in Thailand?

Note: Supplementary sheets may be attached if additional space is required.

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4. In case a company in Thailand is established, please complete the company profile below

Name of Company

Company Registration No. Registration Date

Company Address

Sub-district District

Province Postal Code

Tel. E-mail

Registered capital Baht, Paid-up capital Baht

Amount of shares Value per share____ baht

Shareholding Structure

Thai % of shares Foreign_____________________________% of shares

Details of Foreign Shareholding

Nationality Percentage of Shares

Number of employees Total Annual Sales revenue million

baht

Products/Services (Please elaborate details.)

Product/Service Sales Value (in million baht)

Please attach the company’s annual report, brochures and catalogues. (If any)

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Annual R&D expenditures______________________Million Baht, representing__% of total sales

Number of employees with Master’s degrees or above________________, representing ____% of total

number of employees

Number of employees with a university degree in science and technology fields_______________

5. Contact person in Thailand (if any)

Mr. Mrs. Ms. First Name Middle Name Family Name

Address

Sub-district District

Province Postal Code

Tel. E-mail

I hereby certify that the information and the evidence provided is true and complete in all respects. If there

are any false statements which are considered perjury, I agree to be subjected to any applicable legal

prosecution.

(Signature) Representative (Signature) Applicant

( ) ( )

Date Date

This checklist is for you to identify which documents you are submitting with your application. Further guidance is

available at http://smart-visa.boi.go.th

SUPPORTING DOCUMENTS SUBMITTED Original Copy

1. Completed application form of APPLICATION FOR QUALIFICATION ENDORSEMENT FOR

SMART VISA “S”

2. Valid passport

EVIDENCE OF EMPLOYMENT AND CORPORATE

3. Certificate of incorporation, memorandum of association and company registration certificate in

Thailand (not more than 3 months old) (if any)

4. Company’s annual report, brochures and catalogues. (if any)

ADDITIONAL INFORMATION

5. Medical certificate issued from the country of which the applicant is a national or a permanent

resident or where the application is submitted, showing no prohibited diseases (Leprosy,

Tuberculosis, drug addiction, Elephantiasis, third phase of Syphilis) as indicated in the Ministerial

Regulation No. 14 B.E. 2535

6. Evidence of the incubation or accelerator program acceptance

7. Financial evidence showing fixed saving in Thailand or in a foreign country with balance of not

less than 600,000 Baht per person or equivalence and the remaining maturity term of at least 1 year

*In the case of being accompanied by spouses and children, an additional amount of fixed saving

of at least 180,000 Baht per person or equivalence is required.

8. Health insurance policy covering entire course of stay in Thailand

* Submission of this document can be done separately at a later date before a notification letter is

issued

9. Power of attorney if the application is submitted by a representative

Note:

A letter of verification issued from the country of his or her nationality or residence stating that the

applicant has no criminal record may be requested on a case-by-case basis.

I confirm that I have read the guidance and there are no other documents to submit. For document are not in

English, I have provided a certified translation.

I hereby authorize OSS and related govenmental institutions to share this information provided among the agencies

involved in this qualification endorsement process.

I understand that a decision may be made on my application based on these documents only.

I understand that I may be contacted or requested for additional documents or information from government offices

or its representative.

* All processes may take approximately 30 working days to process providing that you are able to provide all complete

documents at the start, so please allow considerable time to begin the process before your immigration stamp expires.

Applicant’s Name Applicant or representative’s Signature

For Official Use Only

Date: Submission Officer’s Name Signature

Required Documents to be submitted for Qualification Endorsement for Smart visa “S” (Startup)