For Customer Use

Chulalongkorn University Academic Testing Center (CU-ATC)

Registration Report
Name : Suttisak Pruksanusak Application No. : 57030070
Test Schedule and Fee
Test Date Test Applied Test Time Fee (Baht)
8 Jun 2014 CU-TEP 08.30 - 11.30 700.00
Total Registration Fee 700.00

Important Notes : Bank Use Only

1. Payment deadline is on 8 May 2014
2. Non payment or payment after the payment deadline will result in
an automatic cancellation of the registration. Received By ............................
3. Payment made by using the bank's deposit slip will also result in an
automatic cancellation of the registration. Date ......./......./.......
4. Applicants who deposit money into CU-ATC account after the payment
deadline or with improper methods will not be able to get a refund
and will not be allowed to defer registration fee. Signature and Stamp
5. The applicant must keep this part as an unofficial/temporary receipt.
..................................................................................................................................................................

For Bank Use

Chulalongkorn University Academic Testing Center (CU-ATC)

Registration Report

For Deposit into CU-ATC account at : Name : Suttisak Pruksanusak

Application No. (Ref.1) : 570300700570508
Siam Commercial Bank PCL. Ref.2 : 334980007612564
A/C No : 045-3-03857-1 () (15/15)
Amount (Baht) : 700.00
Krung Thai Bank PCL. Amount (In Word) :
Product Code : 80078 (10/10)
-Seven Hundred Baht-
Bank Use Only

: Received By ............................

Date ......./......./.......
Deposit by/Tel. ........................................

The applicant may pay fees at any Siam Commercial Bank or Krung Thai Bank counter, Internet Banking or ATM in Thailand.

Payment deadline is on 8 May 2014 **Cash Payment Only**

099400016390802 570300700570508 334980007612564 70000