E-Service

Application Form for the Course on
“Public Debt Management and Debt Sustainability”
June 2021
Neighbouring Countries Economic Development Cooperation Agency (Public Organization) (NEDA)
14th Fl., Sun Tower Bldg.A, 123 Vibhavadi-Rangsit Rd., Chomphon, Chatuchak, Bangkok 10900 Thailand
Please upload only .jpg and .gif files, the images should be uploaded for 200 x 200 pixels.

1. Personal Data
Mr.
Mrs.
Ms.
Contact Information

2. Professional History
• Job Record (After Graduation)
1

3. Educational Qualifications
1

4. Other Information
Language Skills
English
Listening Speaking Reading Writing
Certificate (if any)
TOEFL
TOEIC
Mother Tongue
Listening Speaking Reading Writing
Other languages
Listening Speaking Reading Writing

5. Food Restriction (if any)

6. Room type
Non-smoking room
Smoking room

7. Declaration and Signature

8. Please fill the medical report form in the next page
Return Application
To accelerate the application form return procedure, please send all application materials via email to [email protected]
Medical Report (To be completed by applicant)

1. Present Medical Status
No
Yes
No
Yes
  weeks/months
No
Yes

2. Medical History
No
Yes, Please specify
No
Yes, Please specify

3. Other Medical Problems: If you have any medical problems that are not described above, please indicate below.

4. Please upload Medical certificate.

I certify that I have read the above instructions and answered all questions truthfully and completely to the best of my knowledge.
I understand and accept that expense on medical treatment (for any treatment such as injury, health problems, chronic health disease, etc.) is my responsibility. NEDA will only cooperate with insurance agency and proceed claim procedure.