Instructions for an applicant : Please take this form to a notary public; fill out and sign the form 
before the notary public and have the notary public notarize your signatures, and then return the form 
along with your application to “The Royal Thai Embassy (Consular Section), Room 101, 1024 
Wisconsin Avenue, N.W., Washington, D.C. 20007” For further inquiries, call (202) 944 3600. 
I, the applicant whose name appears below, hereby provide my notarized specimen signatures 
hereunder both in Thai and in English before the undersigned notary public as required by the 
Embassy’s regulations to accompany my application for a Thai passport/ Power of Attorney and/or 
Letter of Consent. 
Applicant’s name : (In Thai)………………………………………………………………………….. 
 
 (In English)…………………………………………………………………………..