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BOARD OF INVESTMENT APPLICATION FOR PROMOTION

ELIGIBLE ACTIVITY…………………………………………………………………………..

Date: ……………………..………….

1. Applicant: 1.1 Name…Jeremy…Marker…………………Age…….47.…. Nationality………English………..………..…...

Address……69/13 Moo 6, The Little Village,…Marp-yai-rai,…Soi 26, Nernplabwan Road.…….….……… ……………Blanglamung, Chonburi, …20260….…………………………………………………….………

Telephone…038 730527...…Facsimile…038 730527……E-mail jmarker@petchemconstruction.com…. On behalf of company/co-operative/foundation (in Thai) ………….…………………………………..……. Name in English …PetChemConstruction, Co,. Ltd.………………………..…………………………….… Company/co-operative/foundation is established will be established later. (In case of later establishment, please attach detail statement on applicant’s existing business)

1.2 The representative to contact on matters relating to this application in Thailand: Name…..Jeremy Marker…………………………………………………………………………….………. Address: .….…..………………………Street………………………….. Tambol ……………….………… Amphur ………………………………Province………………………………….Zip code.………..………

Telephone ………………….………..Facsimile…………………..…. E-mail……...………...…..………. 1.3 For the established company/co-operative/foundation/please specify following details

Registration number …………...……..……Date ………..…….… Tax ID No. …………………....……... Registered capital ……………………….. Baht. Paid-up capital .……………………………. Baht Percentage of shareholdings: Thai …..…....…% Foreign …………….% Foreign shareholdings: Nationality ….…….…..…, holding ……% of shares. Nationality ………..….., holding ……% of shares Nationality …………...…, holding ……% of shares. Nationality ……..…..…., holding ….…% of shares According to the attached latest balance sheet dated ………….……..., Assets ………...…..…………Baht Liabilities……….…………..………Baht, Shareholders Equity ……………………………Baht

Address of the office:…..………… Street ………………………………. Tambol ………………..………… Amphur ……………………....……… Province ……………………………………. Zip Code….…………

Telephone……………………………………………Facsimile………………………....….……...……….. E-mail ……………………………………………….. Website………………………….……….………….

Application No. …..…./……….. Received by ………..………….. Date ..………/…….…/…….…

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1.4 List of shareholders holding at least 10 percent of registered capital as shown in 1.3, arranged in order of portion of shareholdings from most to least.

Name of Shareholder Nationality Address/Telephone/Fax/E-mail Percentage of total shares

2. Finances:

2.1 In implementing this project: (Unit: Thousand Baht) The company/co-operative/foundation will not increase registered capital The registered capital of the company/co-operative/foundation will be increased by …………………………………. The company/co-operative/foundation/to be established will have a registered capital of ……………………...…………..

Sources of funds for this project: Paid-in share capital ………………………….………

Retained earnings ….……………………………… Domestic loans ……………..…………………… Foreign loans …………………..……………… Credit from foreign suppliers ……………………….….……… Credit from domestic suppliers ……………………...……...…… Total (Must equal total capital investment as specified in 3.1) ………………………………..

2.2 The registered capital of the company/co-operative/foundation as show in 2.1 represents ……………………………….. shares, at ………………………………. Baht per share Thai shareholdings ……………………….. %, Foreign shareholdings ………………………… % List of shareholders holding at least 10 percent of registered capital, arranged in order of portion of shareholdings from most to least.

Name of Shareholder/ co-investor Nationality Address/Telephone/Fax/E-mail Percentage of

total shares

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2.3 Sources of Loans and Credit: Name of Funding Source Amount of money Currency Country from which

funding was obtained 2.3.1 Financial Institution 2.3.2 Parent company and/or subsidiary

3. Investment:

3.1 Capital investment proposed for this project (Thousand Baht)

1) Cost of construction ………..……….…………… (or rent for a period of longer than 3 years)

2) Cost of machinery ………..……….…………… (or rent for a period of longer than 1 year) 3) Cost of installation ………………….……….… 4) Cost of test-run …………………….…….… Total (For an expansion project, combine costs from #1 to #4) ………………………. 5) Preliminary expenses ……………………..……… 6) Value of other assets ……………………..……… Total (For a newly-established company, combine costs from #1 to #6) ……………………… 7) Cost of land …………..………………… 8) Cost of expertise ……………………….…… 9) Working capital ……………………….……

Grand Total (Combine all costs) ………………………. Note: Costs of construction and machinery, preliminary expenses, and value of other assets are defined according to Office of the Board of Investment Announcement No. Por 1/2545

3.2 Factory site / location of activity: ….. ….………………. Street …………………………………………… Tambol ……..………………..……………………….. Amphur ……………………....……………………. Province ……….. …………………………………….. Zip Code ….………………….…. Industrial Estate/Industrial Zone …… …………………………..……………... …………………………… Site area ……………….. rai Telephone …………………………. Facsimile …………………. ………..

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4. Details regarding nature of project: 4.1 Production capacity according to project investment

Product(s) and byproduct(s) (If any)

Maximum annual production capacity 1) Unit Hours of operation

(hours/day: days/year)

Note 1) Calculated in accordance with maximum capacity of machinery specified in 4.4 and hours of operation specified above.

4.2 Projected production of products listed in 4.1 for the first three years Product(s) Unit 1st year Production 2nd year Production 3rd year Production

and by product(s) (if any) Quantity Quantity Quantity

4.3 Production process. Please specify main machinery to be used in each process. (Supplementary sheets may be attached if additional space is required.)

Production process Main machinery to be used

………………………………………………………… …………………………………………………………

………………………………………………………… …………………………………………………………

………………………………………………………… …………………………………………………………

………………………………………………………… …………………………………………………………

………………………………………………………

…………………………………………………………

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4.4 Main machinery (listed in 4.3) and other machinery to be used in this project (Value unit: Thousand Baht)

Imported Purchased locally New Used New Items Country

of origin Quantity Value 1) Quantity Year of

manufacture Value 1) Quantity Value 1)

Note: 1) Please use CIF price for imported machinery & equipment and contracted price for machinery & equipment purchased locally

2) In case of importing used machinery aged over 10 years, please also submit supplementary form for using imported used machinery aged over 10 years (F PA PP 16).

4.5 Specific details regarding the nature of the product, including its use and Harmonized System (HS) code. (Please attach photos, illustrations or catalog.) ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

4.6 Environmental protection plan Type of waste Quantity/year Treatment Methods

Solid waste - …………………………………… - ……………………………………

……………………… ………………………

………………………………………… …………………………………………

Waste water - ………………………………….. - ……………………………………

……………………… ………………………

………………………………………… …………………………………………

Dust/air pollution - ……………………………. - …………………………………..

……………………… ………………………

………………………………………… …………………………………………

Project subjected to obtain an Environmental Impact Assessment (EIA) approval Expansion project of existing project with ISO 14000 certification (please attach a copy of certificate)

Note: Activity in category 1.5.2, 1.6, 1.9, 1.10, 1.11, 1.12, 1.14, 1.15, 1.16, 1.26, 2.15 (if used asbestos), 3.1 (with bleaching & dying process), 4.11, 5.3.2, 6.1, 6.2, 6.5, 6.7, 6.10, 6.11 (except projects located in industrial estate, projects subjected to obtain an EIA approval, and expansion project with a ISO 14000 certification), please complete an preliminary environmental impact evaluation form (F PA PP 15) as an attachment.

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4.7 If the company/co-operative/foundation has commenced operation, please indicate production capacity and performance of both promoted and non-promoted activities in the last 3 years. (Hours of operation……………………hours/day: ………………….days/year)

(Value unit: Thousand Baht) Domestic sales Exports Product Year

Maximum

capacity per year Current

production Quantity Value Quantity Value 1. …………………………………………

2. …………………………………………

3. …………………………………………

4. …………………………………………

5. …………………………………………

………………………………………………………………………………………

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4.8 Employment and net profit in the last 3 years

Employment Net Profit (Loss) (in Thousand Baht) Year No. of Thai employee No. of Foreign employee As of (Date) …………………

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5. Raw and essential materials: (Value unit: Thousand Baht) First year Second year Third year

Imported Purchased locally Imported Purchased locally Imported Purchased locally Item Quantity Value Quantity Value Quantity Value Quantity Value Quantity Value Quantity Value

1. …………………………… Unit …………………………..

………... ……… ……… ………. ……… ………. ………... ………. ……….. ………. ……… ……….

2. …………………………… Unit …………………………..

………... ……… ……… ………. ……… ………. ………... ………. ……….. ………. ……… ……….

3. …………………………… Unit …………………………..

………... ……… ……… ………. ……… ………. ………... ………. ……….. ………. ……… ……….

4. …………………………… Unit …………………………..

………... ……… ……… ………. ……… ………. ………... ………. ……….. ………. ……… ……….

5. …………………………… Unit …………………………..

………... ……… ……… ………. ……… ………. ………... ………. ……….. ………. ……… ……….

6. …………………………… Unit …………………………..

………... ……… ……… ………. ……… ………. ………... ………. ……….. ………. ……… ……….

7. …………………………… Unit …………………………..

………... ……… ……… ………. ……… ………. ………... ………. ……….. ………. ……… ……….

8. …………………………… Unit …………………………..

………... ……… ……… ………. ……… ………. ………... ………. ……….. ………. ……… ……….

9. …………………………… Unit …………………………..

………... ……… ……… ………. ……… ………. ………... ………. ……….. ………. ……… ……….

10. …………………………… Unit …………………………..

………... ……… ……… ………. ……… ………. ………... ………. ……….. ………. ……… ……….

Total

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6. Manpower: Total employment created when this project reaches full production.

Thai Foreign Position No. of employees No. of employees Nationality

Management personnel ………………. ………………. ………………… Technical specialists ………………. ………………. ………………… Supervisory staff ………………. ………………. ………………… Office and clerical staff ………………. ………………. ………………… Skilled and semi-skilled workers ………………. ………………. ………………… Unskilled workers ……………… ……….……… …………………

Total 7. Market: 7.1 Market Plan

Domestic sale …………………………% Including indirect export

Export sale ………………………….%

7.2 Major customers Name Country 1. ……….………………………………………..…………… …….....................…………. 2. ………………………………………..…………………… .…………………………..…. 3. ……………………………………………………………… ………………………………. 4. ……………………………………………………………… ………………………………. 5. ……………………………………………………………… ……………………………….

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8. Costs and profits: 8.1 Estimate of production costs and profits for the first three years of operation

(Unit: Thousand Baht) Items First year Second year Third year

Revenue Domestic Overseas

Total

……………………………… ………………

……………………………… ………………

……………………………… ………………

Expenses Raw and essential materials costs (Total value from item 5): Domestic Foreign Labor costs (Salary and wages only): Domestics Foreign Public utilities costs 1) Depreciation costs 2)

Sales and administrative expenses Interest charges: Domestic Foreign Technical fees and royalties: Domestic Foreign Other costs

Total

……………… ………………. ……………… ……………… ………………………………………………………………………………………………………………………………………………………………………………………………………………

……………… ………………………………. ……………… ………………………………………………………………………………………………………………………………………………………………………………………………………………

……………… ………………………………. ……………… ………………………………………………………………………………………………………………………………………………………………………………………………………………

Profit (Loss) ……………… …………….. …………….. Note: 1) e.g. costs of water supply, electricity, telephone, etc. 2) Calculation of Depreciation must be in accordance with the Revenue Code 8.2 Ex-factory price and profit per unit (At the third year of operation ) Product ………..…………….. ………..…………….. ………..…………….. Ex-factory price Raw and essential materials Public utilities costs Miscellaneous expenses Profit

(฿ /………….) ………………… ………………… ………………… ………………… …………………

(฿ /………….) ………………… ………………… ………………… ………………… …………………

(฿ /………….) ………………… ………………… ………………… ………………… …………………

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9. Request for additional incentives in accordance with Investment promotion policy for STI. Please attach Supplementary Application for Promotion

Privileges in Accordance with BOI’s Investment Promotion Policy to Develop Skill, Technology and Innovation (STI) (F PA PP 14).

Investment promotion policy for HDD. Please attach Supplementary Application for Promotion Privileges in Accordance with BOI’s Investment Promotion Policy to Promote Hard Disk Drive Production Industry (HDD) (F PA PP 18).

Investment promotion policy for SMEs. Please attach Supplementary Application for Promotion Privileges in Accordance with BOI’s Investment Promotion Policy to Promote Thai SMEs (F PA PP 17).

10. Please propose date and time the applicant would like to set up an interview session at the Office of

the Board of Investment.

Proposed application interview session 1) Proposed environmental interview session 2) Date …………………..Time ………………., or On Friday,………………… Time……………, or Date …………………..Time ………………., or On Friday,………………… Time……………, or Date …………………..Time ………………….. On Friday,………………… Time……………….

Note: 1) Application interview session must be scheduled within 10 days of application submission. If the applicant cannot attend an interview within 10 days of submitting this application, please attach detailed explanation of special circumstances. 2) Environmental interview session must be scheduled on Friday between 9.00 –12.00 hrs. I hereby declare that the information contained herein is true and accurate and the estimates provided are, in my opinion, the most reasonable possible. (Signature)………………………………………….. (Signature)………………………………………….. Representative Applicant (…….......................................…………..) (…….......................................…………..)

Date……………………………………… Date……………………………………….

Note: In case that company/co-operative/foundation was established, signature (s) of authorized person(s) affixed with company’s seal is required.