Sasin Graduate Institute of Business Administration of Chulalongkorn University Statement of Applicant Account ( Part 1 For Student ) Print date @PRINT Reference Number @REFNUMBER Student ID: @APPLICANTCODE Name @APPLICANTNAME Session @SEMESTER No. Description Amount(Baht) @01 @02 @03 @04 @05 @06 @07 @08 @09 @10 @11 @12 @13 @14 @15 @T01 @T02 @T03 @T04 @T05 @T06 @T07 @T08 @T09 @T10 @T11 @T12 @T13 @T14 @T15 Please check the correctness all the information before payment @A01 @A02 @A03 @A04 @A05 @A06 @A07 @A08 @A09 @A10 @A11 @A12 @A13 @A14 @A15 @BAHTTEXT Total @TOTAL Payment due date at Sasin's Finance Division or at Siam Commercial Bank @PAYWITHIN หมายเหตุ : หากท่านไม่ชำระเงินภายในวันที่กำหนด สถาบันจะทำการยกเลิกรายการลงทะเบียนของท่าน Bank Use Only Received By …………………………… Date ………./…………../………. ( Sign and stamp) Rip over dot line ( Part 2 For Bank ) Sasin Graduate Institute of Business Administration of Chulalongkorn University Sasa Patasala Building, Phyathai Road, Pathumwan, Bangkok 10330, Thailand Tel: (66) 02-2183870, Fax (66)02-611-8954 Tax ID. 4101030416 Statement Of Student Account **Please collect the service fee from the customer** Payment due date @PAYWITHIN Name: @APPLICANTNAME Siam Commercial Bank A/C @SERVICECODE (Bill Payment) (15/15)* Student ID (Ref. 1) : @APPLICANTID Ref. No. (Ref 2): @REFNUMBER ** Bank Fee 15 Baht** Bank Use Only Amount @TOTAL (Not included bank tranfer fee 15 baht.) Received By Amount in Word @BAHTTEXT Attorney ห้ามธนาคารรับเงินหลังวันที่ @FINALPAY @BARCODE128