1) Applicant's information (individual)

prefix *

 Mr.   Mrs.   Miss

First and last name *

ID card number *

Telephone number *

Current address *

1) Information of the applicant (juristic person)

Legal entity name *

Legal entity registration number *

Name of authorized person signing *

Position *

Telephone number *

Office address (juristic person) *

Name/line of mine shaft *

During the dredging request (start-end) *

area/location (Moo/Subdistrict/District/Province) *

Coordinates (if any)

Landmarks/Nearby Places

Condition of the problem/reason for requesting dredging *

Dredging length (meters) *

Average width (meters) *

Average depth (meters) *

Soil/Sediment Volume (cubic meter)

The desired method of dredging *

 human labor   small machinery   heavy machinery   Other

Specify details (in other cases)

Start date *

End date (approximate) *